Ventricular dysfunction and moderate aortic stenosis are more frequent with advancing age and often coexist. Afterload reduction is one of the main pillars of pharmacological treatment of heart failure, and aortic stenosis (even that of moderate severity) increases the afterload. Nowadays, aortic valve replacement is only formally indicated for symptomatic severe aortic stenosis. This…
CENTERA: Results of the New Self-Expandable Valve
This new device offers the advantage of a lower frame height, which reduces the chance of coronary occlusion. The delivery system is totally motorized and the valve can be repositioned. In addition, the sheath is “14 F” for all valve sizes (23, 26 and 29mm). 203 patients were included, all with severe aortic stenosis…
ARTE: Aspirin or Aspirin and Clopidogrel after TAVR?
Courtesy of SBHCI. This study presented at Euro PCR and simultaneously published by JACC Cardiovascular Interventions poses a question that has remained unanswered since the start of TAVR. There is little information on the optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR). In general, patients receive between 1 and 6 months of dual…
REPRISE III: Lotus and CoreValve Compared in High-Risk or Inoperable Patients
The efficacy of transcatheter aortic valve replacement (TAVR) has been well-established. However, its limitations include suboptimal deployment and paravalvular leak. The Lotus system is a fully repositionable and retrievable device with controlled mechanical expansion. It features an adaptive seal to minimize paravalvular leak, it does not require early pacing during deployment, and, given its early…
Further Evidence on Managing Dysfunctioning Bioprostheses with Balloon-Expandable Prostheses
Early experience with the valve-in-valve technique in the treatment of failed bioprosthetic surgical valves in transcatheter aortic valve replacement (TAVR) has yielded acceptable acute procedural results. This turned the technique into another therapeutic option, one that could even cause the reassessment of the age limit for the surgical implantation of a mechanical or bioprosthesis valve.…
Bicuspid Aortic Valve Stenosis Still Challenging for TAVR
Courtesy of Dr. Carlos Fava One of the present challenges of TAVR is bicuspid aortic valve stenosis (AS), since it presents a different distribution and structure, associated to greater and more irregular calcification. There are only small series of devices and their use is still controversial. The study analyzed 561 patients with severe bicuspid…
Post TAVR thrombosis, is it more common than we know?
Courtesy of Dr. Carlos Fava Few post TAVR scenarios remain to be analyzed. One of them is post TAVR valve thrombosis. This event has been reported in around 0.5% of cases, but its incidence, consequences and adequate treatment remain unclear. The study analyzed 642 patients undergoing TAVR. Patients were followed up with Doppler Echocardiography…
Cardiovascular MR Perfusion Imaging: Good Initial Alternative in Stable Chronic Angina
In the initial management of patients with stable chronic angina, a non-invasive strategy with cardiovascular MR perfusion imaging seems to provide similar results to invasive strategies. At one year, MACE rate (combination of all cause death, non-fatal infarction and target vessel revascularization) resulted 3.3% for MRI vs. 3.9% for fractional flow reserve (FFR) informed…
Surgery or TAVR in intermediate risk? Results of the SURTAVI Study
Courtesy of Dr. Gustavo Leiva. Transcatheter aortic-valve replacement (TAVR) with the use of a self-expanding prosthesis is superior to medical therapy in patients with severe, symptomatic aortic stenosis in whom surgical aortic-valve replacement has been associated with prohibitive risk. Among patients considered at high risk, TAVR may be an alternative to surgery. The comparative…
Percutaneous Repair of Paravalvular Leaks After TAVR: The Challenge of Identifying Eligible Subjects
Courtesy of Dr. Carlos Fava. This study enrolled 72 patients who underwent transcatheter aortic valve replacement with an Edwards Sapiens valve, and then experienced a leak of at least moderate severity. Fifteen of them underwent a percutaneous leak repair after identification of the leak mostly through the presence of symptoms. Both groups were similar. Patients who…
MANTA Closure Device for large-bore arteriotomy closure: Is It Safe?
Courtesy of Dr. Agustín Vecchia. The number of transcatheter aortic valve replacements (TAVR) and the placement of aortic endoprosthesis and ventricular assist devices, among others, have grown exponentially worldwide in the last few years. In a short time, many of these procedures will surely become the new standard of care. Logically, this growth comes hand in hand…