Paravalvular Leak (PVL) occurs in 5 to 17% of patients undergoing surgical valve replacement. Percutaneous device closure of PVL represents an alternative to repeat surgery. All centers in UK and Ireland performing percutaneous PVL closure delivered their data to the UK PVL registry. Data were analyzed for factors associated with mortality and major cardiovascular…
Late Mortality in TAVR Is Mainly Due to Non-Cardiac Causes
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of high-risk patients with severe aortic stenosis. However, survival after the procedure and severe complications have been assessed in relatively small populations with limited follow-up. This article reports long-term clinical results in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. The FRANCE-2 registry…
Stroke Predictors in TAVR: CoreValve vs. Sapien
A comprehensive analyzis of cerebrovascular events in major randomized controlled studies on transcatheter aortic valve replacement (TAVR) has shown some interesting data on both risks and timing of stroke in this setting. The study carried out by Dr. Neal Kleiman, reviewed data on stroke and stroke predictors among 3,687 patients included in the CoreValve…
Paravalvular Insufficiency After TAVR: A Better Predictor of Endocarditis
Data from this large international registry associate endocarditis after a transcatheter aortic valve replacement (TAVR) with high rates of early and late mortality, and might help find predictors identifying patients with the highest risk of developing this rare but dangerous complication. So far, information on endocarditis after TAVR was limited to small populations. In…
New TAVR Devices: Better Results in Bicuspids
Courtesy of del Dr. Carlos Fava. The bicuspid aortic valve is highly anatomically challenging because of valve asymmetric calcification, increased annulus diameter, raphe calcification and ascending aorta dilation. The new valves have shown to improve results, but we still lack data on this group. 301 patients presenting bicuspid aortic valve undergoing transcatheter aortic…
SAPIEN 3: Low One-Year-Mortality in High Risk or Inoperable Patients
In the first PARTNER trial (Placement of Aortic Transcatheter Valves), mortality at one year was 24% for high risk patients and 31% for inoperable patients. A recent report on SAPIEN 3 outcomes at 30 days ─ the last generation balloon expandable valve ─ showed a rather lower adverse events rate. However, additional information at longer…
Bivalirudin or Heparin to Decrease Cerebral Embolization Post TAVI?
Cerebral embolization is a relatively frequent complication during transcatheter aortic valve replacement (TAVR). The hypothesis behind this study is that the incidence of cerebral embolization might be decreased by anticoagulation with bivalirudin, instead of heparin. The first study objective was to determine the proportion of patients with new cerebral embolus after TAVI and…
Pre-TAVI Mitral Regurgitation Is Associated with Higher Mortality
Courtesy of Dr. Carlos Fava. This study sought to analyze the clinical impact and the level of improvement of mitral regurgitation (MR) in patients who receive a transcatheter aortic valve replacement (TAVR), and to find potential candidates for double valve repair with percutaneous techniques. Of 1.110 patients included, 177 (15.9%) suffered from severe pre-TAVR mitral…
Sex Specific Outcomes: Women after TAVI
Courtesy of Dr. Carlos Fava. The benefits of transcatheter aortic valve implantation (TAVI) have been widely shown, but there is no evidence on sex-specific outcomes. Some studies have shown lower mortality and better evolution of the ventricular function in women, yet with more bleeding and stroke; however, it remains unclear. This study included 1,019 patients…
Low BMI Is a Predictor of Death for TAVI
Courtesy of Dr. Carlos Fava. Body mass index (BMI) has always played an important role in heart surgery. However, there is little evidence on BMI effects on TAVI. This study included 491 patients, which were divided according to BMI into: low (<20 Kg/m2 ) normal (20-24.9 Kg/m2 ) overweight (25-30 Kg/m2 ) obese…
A New Score to Predict Post TAVI Mortality
Few studies have evaluated the impact of new comorbidities, fragility and disability indices on transcatheter aortic valve replacement (TAVI) outcomes. This study analyzes Medtronic CoreValve U.S. Pivotal patients to develop a new, simpler scoring system to use in addition to the standard assessment of TAVI patients. A multidisciplinary heart team used objective criteria, the…