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Aligning Prosthetic Valves to Native Commissures: The Secret to Coronary Artery Obstruction?
Preventing coronary artery obstruction during transcatheter aortic valve replacement (TAVR) continues to be a challenge. There are techniques to prevent (or at least reduce) this from happening, which could be catastrophic. However, they all somehow fall into palliative care, that is, they will merely provide relief, rather than a cure. Commissure overlapping and the resulting…
Myocardial Fibrosis in Severe Aortic Stenosis: A Matter of Sex?
Courtesy of Dr. Carlos Fava. Aortic valve calcification and its resulting stenosis leads to changes in left ventricle hemodynamics, producing diffuse ischemia followed by inflammation, increased extracellular matrix, necrosis, and later, diffuse fibrosis. At present, with magnetic resonance imaging (MRI) we can analyze ventricular architecture and its function by detecting fibrosis (LGE) and its volume…
In Search of the Optimal Depth for Self-Expandable Valves
Despite the use of the different imaging approaches to calculating implantation depth, optimal depth is reached only 30% of the time. Multiple imaging does not offer a uniform perspective and therefore influence reporting. Basically, we do not have a clear idea of what constitutes optimal depth on a case by case basis and, what is…
Does Surgeon (Instead of Operator) Experience Affect TAVR?
There is a correlation between the volume of conventional surgical aortic valve replacement procedures and better outcomes in transcatheter aortic valve replacement (TAVR), with higher 30-day and 1-year mortality in sites with lower volume. This is a probable indication that a good surgical team is complemented by a good hemodynamic team and, ultimately, a good…
TAVR Long-Term Durability: from the Cath Lab to Real Life
Nominally deployed transcatheter heart valves SAPIEN 3 has shown excellent durability in accelerated testing to an equivalent 25 year-wear. S3 durability resulted comparable to surgical biological valve durability. Non-nominal implants (overexpansion, underexpansion, and elliptical) also showed excellent durability to an equivalent 5 year-wear. The aim of this study was to test nominally deployed S3 durability to 1 billion…
Cerebrovascular Events After TAVR May Be Especially Serious
Stroke events do not seem to be related to valve thrombosis or structural degeneration, but to a higher baseline risk in patients who undergo transcatheter aortic valve replacement (TAVR). About 1 in 20 patients who underwent TAVR experienced a stroke or transient ischemic attack during follow-up. According to this new analysis, the consequences of these events…
SURTAVI Follow-Up Completed with Good News
The assessment of all severe aortic stenosis patients at intermediate risk of the SURTAVI was finally completed, confirming inferiority against the traditional surgical replacement (SAVR) in hard points such as all-cause mortality and disabling stroke. The aim of this study was to report SURTAVI 2-year outcomes (Surgical Replacement and Transcatheter Aortic Valve Implantation) and confirm…
TAVR Reaches Low-Risk Patients with Bicuspid Valves
Transcatheter aortic valve replacement (TAVR) seems to be safe in low-risk patients with bicuspid aortic valve stenosis. Their hospital length of stay was very short, with zero mortality, and zero disabling stroke. Subclinical leaflet thrombosis and device durability are still unknown. The United States Food and Drug Administration (FDA) approved TAVR for low-risk patients. However,…
Procedural Rescheduling Criteria in the Pandemic Era
Patients with structural heart disease are at higher risk in the face of the new coronavirus infection due to both advanced age and numerous comorbidities. All variables must be taken into account when deciding whether a patient can wait (so as to minimize the risk of exposure to the virus) or their pathology must be…