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…
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…
“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…
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…
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…
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…
Bleeding and Mortality in Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) is much less invasive than surgical replacement. This is associated with a substantial reduction in bleeding events (up to 60% less). However, clinically relevant bleeding is still present in one every four patients who undergo TAVR, which is associated with morbidity and mortality. Cases of bleeding are not uniform: they may…
How to standardize frailty in aortic stenosis patients
Frailty is the patient’s diminished capacity to recover after pathological or iatrogenic processes. It has a fundamental role when considering valve replacement, be it surgical (SAVR) or transcatheter (TAVR). This was clearly observed in the PARTNER I and Core-Valve Pivotal trials, which showed that despite a 95% technical success, 2 in 5 patients showed poor quality…
Incomplete Revascularization Is Associated with Mortality in TAVR
Courtesy of Dr. Carlos Fava. TAVR has proven to be beneficial for inoperable and high-risk patients, as well as for intermediate-risk patients. However, while many comorbidities have been analyzed, the presence, severity, and impact of coronary disease has not been well studied yet. This study analyzed 1270 patients who underwent TAVR. They presented >50% lesions in a major epicardial…
Valve Deterioration after TAVI Is Rare and Should Not Prevent Advancement to Younger Populations
Durability ─or better yet, lack of deterioration─ is still a matter of debate when considering transcatheter aortic valve intervention (TAVI), especially now that it is being explored as a real alternative for younger patients. A recently published meta-analysis offers more evidence and suggests TAVI deterioration is mostly rare within the first 5 years. According to…
SOLACI CACI 2017 | When is the optimal timing for PCI: before or during TAVI
Read articles on the main presentations of the third day of SOLACI-CACI 2017 Congress. See the presentation by Dr. Conrad Simpfendorfer, entitled “When is the optimal timing for PCI: before or during TAVI”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.