Courtesy of Dr. Carlos Fava. The need for anticoagulation after transcatheter aortic valve replacement (TAVR) is over 15% according to different reports and, so far, no one has analyzed in depth whether new oral anticoagulant agents (non-vitamin K oral anticoagulants [NOACs]) result in superior benefit compared with classic vitamin K antagonists (VKAs). This study analyzed…
FDA Expands TAVR Indication to Low-Risk Patients
Both the self-expandable valve Evolut R and its direct competitor, balloon-expandable valve Sapien 3, received the authorization to be indicated for low-risk patients in a long-awaited announcement made on August 16th, 2019. The US Food and Drug Administration (FDA) has approved and expanded the indication for the Evolut series (Medtronic) and the Sapien 3 and…
Loss in Life Expectancy after Surgical Aortic Valve Replacement
This study found after surgical aortic valve replacement (SAVR) patients had shorter life expectancy, compared against the general population. This loss in life expectancy was significant, especially in young patients. These results provide essential information to advice patients before and after SAVR. This is an observational national cohort study to assess long term relative survival…
Clinical Implications of the New Hypertension Guidelines
Hypertension is the first modifiable risk factor affecting morbidity and mortality in nearly half of the adults in the US. The new ACC/AHA guidelines have issued new standards for the detection assessment and management of high blood pressure. The major change compared against their prior version was stage 1 hypertension definition, defined as systolic blood…
Next-Day Discharge after TAVR: Equally Safe for All Prosthesis?
Yet scarce, there is evidence supporting next-day discharge (NDD) after TAVR is safe when patients receiving balloon expandable valves meet certain conditions. This had not yet been shown for self-expandable valves. This study looks into NDD after TAVR by femoral access with self-expandable valves. The authors retrospectively compared all consecutive patients undergoing elective minimalist TAVR…
Prosthetic Valve Endocarditis and TAVR: though Rare, Devastating
On the bright side, the incidence of prosthetic valve endocarditis (PVE) post TAVR is not higher than post SAVR, according to this study recently presented at EuroPCR 2019, held in Paris. There is plenty of evidence describing PVE incidence, prognosis, risk factors, etc. after surgical valve replacement surgery (SAVR). However, we know little about the…
Valve-in-Valve with Self-Expanding Prosthesis: What Happens with Gradients at One Year?
Degenerated surgical bioprostheses can be safely treated with CoreValve or CoreValve Evolut using the valve-in-valve procedure. Excellent 1-year clinical and hemodynamic outcomes were achieved in a non-selected regular population, i.e., “real-world” patients. The VIVA (Valve in Valve) registry, conducted at 23 sites, was a prospective study designed to systematically collect data from patients with degenerated…
Pulmonary Hypertension: No Reason for TAVR Contraindication
In most severe aortic stenosis patients with pulmonary hypertension, transcatheter aortic valve replacement (TAVR) reduced pulmonary systolic pressure. There patients presented lower risk and lower all-cause mortality at short, median and long term. This data show that pulmonary hypertension should not be a TAVR contraindication. Pulmonary hypertension is common among TAVR patients. The most frequent…
Low-Risk TAVR Trending in All Papers
Transcatheter aortic valve replacement (TAVR) in low-risk patients with symptomatic severe aortic stenosis appears to be safe at one year. In a follow-up using computerized tomography (TC), hypoattenuated leaflet thickening was observed in a minority of patients, but it did not have a long-term hemodynamic impact. It should be noted that the management strategy for…
Safe for 80-Year-Olds. Should Nonagenarians be Withheld from TAVR?
According to this large global registry, mortality after transcatheter aortic valve replacement (TAVR) is twice as high in nonagenarians as against the “younger” group (90 patients. Additionally, risk scores cannot be trusted given that on the one hand they were designed for patients with planned surgery, and on the other hand, they included few patients…
Outpatient Rhythm Monitoring After TAVR Could Save Us from Some Pacemakers?
Delayed high-grade block after transcatheter aortic valve replacement (TAVR) goes unnoticed in patients undergoing TAVR without prior conduction disorders because, most times, it takes place during hospitalization or immediately after the procedure. Right bundle branch block is a risk factor, but it has poor sensitivity for the prediction of high-grade blocks, and there may be…