This small randomized study heated the debate about when to intervene aortic stenosis (AS). Putting off surgical valve replacement (SAVR) in patients with asymptomatic AS and waiting for symptom onset with conservative care increased periprocedural risk and all cause cardiovascular death. This study presented by Dr Duk-Hyun Kang during AHA 2019 scientific sessions (simultaneously published…
AHA 2019 | GALILEO-4D: Rivaroxaban in the Prevention of Post TAVR Valve Thickening and Thrombosis
This sub study of the GALILEO specifically looked at valve thickening and reduced leaflet motion after TAVR documented with 4D CT. Whether anticoagulation with rivaroxaban might reduce or prevent this phenomenon remained unanswered. Patients receiving the same anticoagulation scheme than the general study’s (rivaroxaban + aspirin vs. aspirin + clopidogrel) were assessed by 4D CT…
Temporal Trends and Outcomes of TAVR in Bicuspids: Are We Any Better?
This large registry has shown bicuspid aortic stenosis (AS) patients have similar mortality with transcatheter aortic valve replacement (TAVR) compared against surgical valve replacement (SAVR). TAVR outcomes in this population are not only similar to SAVR outcomes, but also to TAVR outcomes in patients with conventional aortic valve anatomy. Despite the good news, these outcomes…
Europe Grants Approval to Balloon-Expandable Valve in Low-Risk Patients; Self-Expanding Valve Still Waiting for It
The balloon-expandable valve has been granted approval in Europe for treatment of the complete risk spectrum of symptomatic severe aortic stenosis. Europe has recently approved an expanded indication for the Sapien 3 system for use in low-risk patients, as reported by Edward Lifesciences. Sapien 3, which includes the next-generation Sapien 3 Ultra, is the first transcatheter heart valve…
Negative Impact of Pulmonary Hypertension in TAVR
Courtesy of Dr. Carlos Fava. The presence of pulmonary hypertension (PH) is frequent in severe aortic stenosis. This can be classified in: isolated pre-capillary PH, isolated post-capillary PH, and combined post-capillary and pre-capillary PH. At present, little research has looked into the disease from this perspective. The study looked at 1400 patients and divided them…
Infective Endocarditis After TAVI
Infective endocarditis after transcatheter aortic valve implantation (TAVI) is one of the most feared complications due to its morbidity and mortality. With the expansion of TAVI into all risk groups, endocarditis might be a long-term concern. However, its long-term risk seems similar to that of endocarditis with surgically-implanted biological valves; consequently, it should not affect…
Venous Pulmonary Waveforms in MitraClip Have Prognostic Value
Courtesy of Dr. Carlos Fava. The MitraClip has been shown to benefit a certain group of patients and it is a well-known fact that a ≥5 mmHg is associated to a more torpid evolution. However, there is little evidence when it comes to venous pulmonary waves, changes in left atrial pressure and V wave. 121…
Prosthesis Mismatch in Supra and Intra Annular valves
The self-expandable valve was associated to lower prosthesis-patient mismatch (PPM) compared against the balloon expandable valve regardless annular area, according to this study soon to be published in J Am Coll Cardiol Intv. This difference was basically driven by patients with larger body surface area (>1.83m²). Prosthesis mismatch has been associated to increased mortality after transcatheter…
Meta-Analysis of Large TAVR Studies on Low-Risk: Evidence is Consistent
This meta-analysis which included the 4 large randomized studies on transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in low-risk patients recently published in JACC, showed TAVR is associated with significant lower mortality compared against SAVR at one year follow up. These results add to the mounting evidence showing that when it…
1000 MitraClips: Results from the World’s Most Experienced Site
In September 2008, interventional physicians at the Heart and Vascular Centre Hamburg conducted the first MitraClip implantation after its Conformité Européenne (CE)-marking approval. In July 2019, the same site reached an amazing milestone, 1000 MitraClips implanted, and in doing so it became the most experienced site in the world. Those 1000 patients treated had an average logistic…
Incidence and Prognosis of Heart Valve Embolization
The incidence of peri-procedural transcatheter heart valve embolization and migration (TVEM) is as low as 1%. However, it is associated with increased morbidity and mortality. Peri-procedural TVEM is one of the most feared complication given its potential to transform the procedure into a catastrophe, but little do we know about its incidence (except for a…