Valvular Aortic Valve articles

Cirugía para mejorar la sobrevida en insuficiencia tricuspidea aislada

Tricuspid and Bicuspid Valves Present More Coincidences Than Expected

Tricuspid and Bicuspid Valves Present More Coincidences Than Expected

There is more and more positive evidence that new-generation transcatheter valves, originally designed to treat tricuspid aortic valves, work perfectly fine on bicuspid aortic valves. A comparison of computerized tomography (CT) scans obtained before and after the procedure showed that the most commonly used devices appear to reshape the aortic annulus to the same degree

¿Cateterismo o cirugía para el cierre del leak paravalvular?

Transcatheter Reduction or Surgery for Paravalvular Leak Repair?

Paravalvular leak is complication derived from incomplete sealing between the implanted prosthesis and the native annulus, which occurs in 5% of all patients who undergo mitral valve replacement and 10% of those who undergo transcatheter aortic valve replacement. This is the most frequent non-structural valve dysfunction. While mild leaks can be asymptomatic, moderate to severe

¿Fin de la discusión sobre el impacto del marcapaso post TAVI?

End of Discussion on the Impact of Pacemaker After TAVR?

Transcatheter aortic valve replacement (TAVR) is often associated with conduction abnormalities, which usually end with permanent pacemaker (PPM) implantation in 10-40% of patients. Factors predisposing to PPM after TAVR have been studied in great detail, but their short- and long-term clinical impact is still controversial.   Recently, outcomes from a large cohort of patients were

Es un hecho: la protección cerebral en TAVI logró demostrar que reduce el stroke y la muerte

It Is a Fact: Cerebral Protection in TAVR Has Proved to Reduce Stroke and Death

Cerebral ischemic events after transcatheter aortic valve replacement (TAVR) have been identified as independent predictors of morbidity and mortality. New-generation devices have managed to partially reduce the rate of cerebral events, but it still is around 5.5% at 30 days for patients undergoing TAVR through transfemoral access. First data on cerebral protection devices had only shown

Sedación consciente en TAVI: ¿Es recomendable?

Conscious Sedation in TAVR: Is It Advisable?

The fundamental advantage offered by transcatheter aortic valve replacement (TAVR) has always been the fact that it is less invasive than surgical valve replacement. So far, most improvements for these devices have derived in less invasiveness (e.g., by improving the profile of the eluting system). However, there are also cases of “deployment” reduction during the

La diálisis nueva post TAVI aumenta la mortalidad.

The need for dialysis after TAVR increases mortality

Courtesy of Dr. Carlos Fava. Stage III or higher renal impairment is frequent before TAVR, and the need for new dialysis after the procedure may reach up to 20%. Within that percentage, 5% may require permanent dialysis, which increases mortality up to 9 times at one year. In that sense, factors leading to that complication have not

Los marcapasos post TAVI aumentan los costos pero no los eventos adversos

Pacemaker Implantation After TAVI Raises Costs But Not the Incidence of Adverse Events

This new meta-analysis did not manage to prove whether permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR) raises the rates of mortality, infarction, or stroke. Implantation could only be associated to a lesser recovery of ventricular function after the procedure, something that had already been observed in previous studies. Patients who required a pacemaker undoubtedly

La angioplastia “ad hoc” durante el TAVI no impacta en su seguridad ni en resultados a largo plazo

“Ad Hoc” PCI during TAVR: No Impact on Safety or Long Term Outcomes

According to a recent study published in Circulation Cardiovascular Interventions, screening for coronary artery disease (CAD) with an invasive coronary angiography  (as part of the protocol prior TAVR)  and performing PCI and TAVR in the same session, has no impact on periprocedural safety or on long term outcomes. Study outcomes offer new hope, especially as regards using TAVR

La válvula CoreValve Evolut R arroja resultados positivos en una población importante de pacientes La Evolut R, al igual que su predecesora CoreValve, es una válvula autoexpandible, supra-anular, de pericardio porcino en un stent de nitinol. Entre las mejoras de esta válvula se pueden enumerar su mejor perfil y la posibilidad de re-envainarla. Esto la hace completamente reposicionable e incluso recapturable. Faltaba ver si estas ventajas técnicas se traducirían en ventajas clínicas (lo cual es -en definitiva- lo que importa) en una población grande de pacientes del mundo real. El estudio FORWARD (CoreValve Evolut R FORWARD) es un registro prospectivo que incluyó 1038 pacientes de 53 centros y cuatro continentes. Los pacientes tuvieron una edad media de 81.8 ± 6.2 años y un STS de 5.5 ± 4.5%, lo cual constituye un riesgo intermedio y coincide con la tendencia actual de la práctica clínica. La capacidad de reposicionar la válvula debió ser utilizada en el 25.8% de los pacientes, característica que permitió el implante de una sola válvula en el lugar correcto en el 98.9% de los casos. A 30 días, la mortalidad fue del 1.9% y el stroke incapacitante del 1.8%. Solo el 1.9% de los pacientes presentó insuficiencia aórtica moderada a severa; la tasa de marcapaso definitivo fue del 17.5%. Ambos datos están por debajo de lo que mostró el estudio SURTAVI con la CoreValve en una población similar (3.4% y 25.9% respectivamente) y la mejora se puede atribuir a la posibilidad de reposicionar el dispositivo. Conclusión La nueva generación de la válvula autoexpandible es segura y efectiva en pacientes con estenosis aórtica severa no seleccionados del mundo real. Comentario editorial La mortalidad por cualquier causa del 1.9% está claramente por debajo del 5.5% esperado según el score de STS y en sintonía con la del 1.1% descripta en el registro que testeó la última generación de la válvula balón expandible SAPIEN 3 en una población similar. El 98% de los pacientes fueron tratados por acceso femoral, lo cual también es la tendencia mundial gracias a la significativa disminución del perfil de los dispositivos. Afortunadamente, la enorme mayoría de las mejoras técnicas que han incorporado los nuevos dispositivos (tanto este como la competencia) han logrado traducirse en mejoras clínicas para los pacientes, logrando reducir la insuficiencia paravalvular, la tasa de marcapaso y las complicaciones vasculares. Título original: Clinical Outcomes With a Repositionable Self-Expanding Transcatheter Aortic Valve Prosthesis. The International FORWARD Study. Referencia: Eberhard Grube et al. J Am Coll Cardiol 2017;70:845–53.

Positive Outcomes of CoreValve Evolut in Large Population

The Evolut R, as well as its predecessor the CoreValve, is a self-expandable valve, supra-annular, made of porcine pericardium in a nitinol frame. Amongst its improvements, it has a better profile and the option to resheath. This makes it fully repositionable and even recapturable.   We only needed to confirm these technical advantages would translate into clinical

Predicción de mortalidad en TAVI - Marcapaso

A Simple Electrocardiography to Predict Mortality in TAVR

Conduction abnormalities, such as new left bundle branch block, atrioventricular block, and need for a pacemaker, are still among the most frequent complications in transcatheter aortic valve replacement (TAVR). New valve generations have (mostly) not managed to reduce significantly electrical abnormalities; furthermore, some modifications such as external skirts, which are extremely effective for the reduction

Diálisis post TAVI, una complicación grave que se hace menos frecuente

Post TAVR Dialysis: a Severe Complication Less and Less Frequent

The prevalence of pre-procedural kidney failure in patients undergoing transcatheter aortic valve replacement (TAVR) can be as high as 50 – 60% (stage 3 kidney failure or worse); it has been strongly associated with acute kidney deterioration and, ultimately, an increase of post TAVR mortality. A recent meta-analyzis of several small studies carried out in a single

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