The consequences of deferring transcatheter aortic valve replacement (TAVR) procedures because of the COVID 19 pandemic are piling up. Untreated severe aortic stenosis patients who had been scheduled for TAVR are seeing increased risk of all events, even mortality. According to recent studies published in JAMA, deferring TAVR in patients with symptomatic aortic stenosis is…
Post TAVR ASA Monotherapy Consolidates
This meta-analysis to be published in J Am Cardiol supports the use of aspirin monotherapy (ASA) after transcatheter aortic valve replacement (TAVR). The use of aspirin alone is associated to less bleeding without increased ischemic events such as strokes or mortality. The combined outcomes of four studies, including the recently published POPular TAVI (cohort A),…
Minimalist TAVR to the Max
Transcatheter aortic valve replacement (TAVR) is increasingly being performed under conscious sedation, which is associated with a multi-point benefit (including mortality). This paper, recently published in JACC Intv., shows that general anesthesia is becoming obsolete, although the magnitude the benefit derived from conscious sedation appears to be lower than in previous studies. The aim of…
Size Does Matter for Long Term ViV
The size of the original bioprosthetic valve impacts long term mortality, as does the type of bioprosthetic valve used in percutaneous reinterventions. The number of patients with failed bioprosthesis is on the rise, mainly due to increased life expectancy. Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become more and more common these days and…
TAVR as Anti-Inflammatory? An effect few imagined
We never saw it coming, such a pleiotropic effect: who would have though a mechanical device could have such a systemic anti-inflammatory effect? Transcatheter aortic valve replacement (TAVR) does in fact have it. The shear stress aortic stenosis produces activates multiple inflammatory responses mediated by monocytes. This study identified the most important mechanoreceptor, involved in…
Considerations for Optimal Device Selection in TAVR
Many studies have tried to answer the question about whether there is a superior device in transcatheter aortic valve replacement (TAVR). Today, there is no evidence to support such claim, and most patients will likely find operator experience more beneficial than any device per se. However, there are certain patients with specific characteristics that might…
TAVR After Endocarditis? Contraindication or Last Resort
Transcatheter aortic valve replacement (TAVR) can be an alternative for aortic valves with endocarditis successfully treated with antibiotics, which no longer are severe valve lesions. At one year, the risk of endocarditis relapse was low and the mortality rate was similar to that of patients without a history of infection. This aim of this study…
Same Contrast Dose, Different Risk of Kidney Injury, Depending on Procedure
The risk of contrast induced kidney injury is significantly lower in patients receiving transcatheter aortic valve replacement (TAVR) compared against patients getting a coronary angiography or angioplasty. This is true even for valvular heart disease patients with higher risk profiles. Differences in contrast-induced acute kidney injury between TAVR or coronary patients had not been previously…
Outflow Tract Calcification and the Best Valve in This Context
Moderate or severe left ventricle outflow tract calcification increases the risk of annulus rupture, residual aortic regurgitation and the need for a second valve. This recent study analyzed the performance of different contemporary prosthetic valves in patients with this particular anatomy. Since the early days of transcatheter aortic valve replacement (TAVR) outflow tract calcification has…
ESC 2020 | Against the Grain, ASA Monotherapy Appears Superior after TAVR
After TAVR, patients with no anticoagulation indication are favored by monotherapy with aspirin (ASA) vs. dual antiaggregation therapy (DAPT). This study presented at ESC 2020, simultaneously published in NEJM, seems to go against the latest “fashion” (P2Y12 inhibitor monotherapy) and randomized patients to ASA monotherapy vs. DAPT with clopidogrel for 3 months. Unlike with the…
3rd Generation Valves in Large and X-Large Annuli
In patients with large and extra-large annuli, transcatheter aortic valve replacement (TAVR) is safe and feasible with 3rd generation valves: the 29mm balloon expandable valve Sapien-3, and their competitor, the self-expandable 34mm Evolut R. The largest size of both devices was designed specifically for patients with large or extra-large annuli. However, one of them seems…