Coronary obstruction is a complication from TAVR that can cause death (up to 50% mortality), even though its incidence is lower than 1%. One of the most frequent strategies used in the prevention of this complication is chimney stenting in patients at high anatomical risk (valve in valve, narrow sinotubular junction, short coronary ostium height).…
EuroPCR 2023 | Events after Redo TAVR in Balloon-Expandable Valves
With the treatment of aortic valve disease in younger patients, a significant number of them will need redo TAVR at some point in their life. However, to date there are few data on redo TAVR. The aims of this study was to look at real life experience on redo TAVR with balloon-expandable SAPIEN valves and…
Latest Developments in Tricuspid Regurgitation
The natural history of tricuspid regurgitation is associated to hospitalization for cardiac failure and mortality. This is why the AHA/ACC guidelines recommend surgery when the tricuspid fails during left valve surgical repair, because its slow progression is associated with high mortality (35%). Many of these patients are high risk and percutaneous intervention has surged as…
Low Gradient Aortic Stenosis: Is Invasive Assessment Viable?
There is an important group of patients presenting low flow, low-gradient severe aortic stenosis (defined as mean gradient <40 mmHg). This is why we do dobutamine stress echocardiogram (DSE), to confirm whether we are dealing with truly severe aortic stenosis. However, it might not be well tolerated and a CT angiography will be done to…
Redo Surgical Aortic Valve Replacement after Prior Transcatheter vs Surgical Aortic Valve Replacement: A Growing Population
Transcatheter aortic valve replacement (TAVR) has evolved since it was first implemented, and it is now also used to treat low risk patients. One of the questions this has raised is whether patient life expectancy is higher than prosthesis life expectancy. The growing population in need for valve replacement also poses the question of how…
BASILICA: a Complex Strategy, Yet Safe
Coronary artery obstruction (CAO) after TAVR is rare, but it entails extremely high mortality (50% or more), especially after valve-in-valve (V-in-V) or when the coronary ostia are is too close to the valve annulus. This is why the BASILICA technique was developed (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction).…
Sex-Related Differences in Clinical Outcomes after Transcatheter Tricuspid Valve Intervention
We are aware of sex related differences when it comes to comorbidities, physiopathology and disease evolution in patients with tricuspid regurgitation (TR). TR is more prevalent among women, whereas among men, coronary artery disease is more prevalent, with worse left ventricular ejection fraction and 10-year survival rate. Transcatheter tricuspid valve intervention (TTVIs) has surged as…
Is There a Way to Reduce the Need for Permanent Pacemaker Implantation in Self-Expanding Valves?
We are well aware of the benefits of TAVR in different scenarios, but the need for permanent pacemaker implantation (PPI) in self-expandable valves is between 15% and 30% according to different randomized and non-randomized studies. This is why the higher implantation strategy or cusp overlap (COT) was developed and, though it has been shown to…
Percutaneous Access Closure in TAVR: Are Devices Similar?
One of the challenges that transcatheter aortic valve replacement (TAVR) continues to face is percutaneous access closure with percutaneous closure systems (PCS). However, several systems have been developed, either by plug—such as the MANTA system—or by suture (SU)—such as the ProStar and ProGlide systems. Both of these have been tested in different analyses, but to…
Have Complications Related to Balloon Pulmonary Angioplasty Changed Since its Inception?
Balloon pulmonary angioplasty: Evolution over time and its complications Balloon pulmonary angioplasty (BPA) has grown from its beginnings as an indication for patients with chronic thromboembolic pulmonary hypertension (CTEPH) to being currently a class 1 indication for inoperable patients and/or residual CTEPH. Current evidence on this topic is underpowered, as most reports are based on…
Prosthesis Mismatch in TAVR: It’s Real Impact
Prosthesis-patient mismatch (PPM) was initially proposed by Rahimtoola and reintroduced by Pirabot. PPM is the indexed effective orifice area in relation to body surface area, cutoff value being 0.85 cm2/m2, and <0.70 cm2/m2for obese patients. PPM is considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2 Research studies on surgical prosthesis have…