In some patients, using an anticoagulant agent is not an option, it is just prescribed. Based on the French TAVR registry, this research compared long-term mortality, bleeding, and ischemic events after valve implantation. A comparison was made between TAVR and direct vs. classic anticoagulant agents—good old proven and reversible vitamin K inhibitors. Cardiologists, hematologists, clinicians, and…
Thrombotic and Bleeding Risk after TAVR: Quick Tips to Stay Up to Date
Transcatheter aortic valve replacement (TAVR) is an increasingly frequent option for patients with severe aortic stenosis across the entire risk spectrum. However, TAVR involves bleeding and thrombosis risk and therefore calls for an optimal adjuvant treatment. Any scheme is complex if we take into account most patients undergoing TAVR are generally elderly and have multiple…
SAPIEN 3 Ultra: Lower Incidence of Paravalvular Regurgitation?
Paravalvular regurgitation after transcatheter aortic valve replacement (TAVR) have historically been associated with worse clinical outcomes. Even mild leaks have been shown to be harmful. This study looked at a real-world experience with the transcatheter heart valve SAPIEN 3 Ultra in the US. The SAPIEN 3 Ultra is a new generation balloon-expandable heart valve with…
ESC 2021 | ENVISAGE-TAVI AF: Surprise with Endoxaban in TAVR and Atrial Fibrillation
The enthusiasm for direct oral anticoagulants after transcatheter aortic valve replacements (TAVR) is waning. At least, when it combines with atrial fibrillation. The ENVISAGE-TAVI AF has shown excessive bleeding with endoxaban vs. the classical vitamin K antagonists. Endoxaban resulted non-inferior to vitamin K antagonists in terms of net clinical adverse events, but major bleeding events…
ESC 2021 | Updated European Society of Cardiology Guidelines for the Management of Valvular Heart Disease
Early intervention in asymptomatic valvular heart disease, age recommendations to decide between TAVR and surgery for aortic stenosis, and a push in favor of transcatheter repair in secondary mitral regurgitation are some of the new modifications to the European Society of Cardiology (ESC) Guidelines for the Management of Valvular Heart Disease. This new document was…
New Markers of Aortic Stenosis Define Asymptomatic Patients
Asymptomatic aortic stenosis has been keeping us in tense stillness. However, there are new markers capable of identifying patients that might benefit from earlier intervention. In this regard, cardiovascular magnetic resonance (CMR) has been gaining its well-deserved place in cardiology and now more specifically in aortic stenosis. This study sought to validate CMR markers of…
TAVR Durability Becomes Irrelevant after TRANSIT Outcomes
The international registry TRANSIT has shown treating degenerated transcatheter aortic valves (TAVs) with a second TAVR is safe and effective. These finding are of crucial importance to the definite adoption of TAVR in the lower risk, younger population. Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in severe aortic stenosis treatment. Technological innovation…
Direct TAVR vs. Predilation: Potential Cost of a Simpler Procedure
Does simplifying TAVR involve a cost? At least for low-risk patients included in the PARTNER 3, the question appears somewhat abstract. Predilation and direct TAVR resulted equally safe, though the latter shortened procedural time and did not require further post dilation. Both strategies resulted virtually identical in terms of clinical events. The use of predilation…
European Consensus on Antithrombotic Management in TAVR
All the controlled randomized evidence recently published called for an updated document on antithrombotic management in transcatheter aortic valve replacement (TAVR). While thrombotic and hemorrhagic complications have diminished over time—as both the technique and the devices have been perfected—, they still remain as common adverse events in TAVR. Recommendations in the 2017 European Guidelines were…
Self-Expanding Valve in Extreme Surgical Risk After 5 Years
Patients with aortic stenosis and extreme surgical risk have extremely high mortality due to known comorbidities. The short-term benefit of transcatheter aortic valve replacement (TAVR) with self-expanding valve is clear, and it warrants the procedure in this challenging population. While elderly patients with comorbidities who are at extreme surgical risk might be eligible for TAVR,…