Mitral regurgitation (MR) is the most frequent type of valve heart disease, and the COAPT has shown that edge-to-edge with guideline directed medical treatment (GDMT) at maximal tolerated dose (MTD) is superior to medical treatment alone. However, we did not have a score to predict patient evolution when treated with this strategy. Researchers analyzed the…
Prognostic Impact of Acute Kidney Injury Following Tricuspid Transcatheter Edge-to-Edge Repair
Tricuspid failure (TF) mostly affects the elderly and, because of this, is associated with comorbidities that increase surgical risk. Tricuspid edge to edge repair (TEER) has surged as a valid alternative for the mitral valve in high-risk patients and, at present, is increasingly being used for tricuspids. One of the complications following TEER is acute…
TCT 2022 | PROTECTED TAVR
Stroke is still a major complication of transcatheter aortic valve replacement (TAVR), with a 30-day mortality of 16.7%. Even in the absence of symptoms, most patients (68-93%) have some type of diffusion imaging defect after TAVR implantation. The Sentinel cerebral protection device (CPD) (Boston Scientific) received FDA approval for the capture of emboligenic material that…
TCT 2022 | CLASP II D TRIAL: Transcatheter Edge-to-Edge Repair for Mitral Regurgitation in Patients at Prohibitive Risk
The CLASP IID study was a prospective randomized study to assess the efficacy and effectiveness of the PASCAL transcatheter valve repair system compared with the MitraClip device for patients with degenerative mitral regurgitation (MR) at prohibitive surgical risk. The study included Patients at prohibitive surgical risk, candidates for both devices, with MR 3+ to 4+,…
TCT 2022 | FRANCE-TAVI Registry: Small Annuli
The presence of small annuli, defined in this registry as < 23 mm diameter or indexed diameter <12 mm/m2 by CT, continues to be one of the greatest challenges of both surgical and endovascular aortic valve treatments. The FRANCE-TAVI Registry looked at 1,195 patients presenting small annuli. 895 (74.9%) received balloon expandable valves (BEV) and…
Is the Cause of Mitral Regurgitation Relevant for MitraClip?
Mitral regurgitation (MR) is the most common valvulopathy: it is present in (at least) 7.5% of patients >75 years old. This pathology can be classified as primary or degenerative MR (DMR) and secondary or functional MR (FMR). FMR can be caused by dilatation of the left atrium (most often due to atrial fibrillation), occurring in…
Apixaban and Valve Thrombosis after TAVR
TAVR has been associated with early valve thrombosis, characterized by thrombus formation in the prosthetic valve with or without valve dysfunction. This dysfunction is related to leaflet thickening and reduced motion, reduced effective orifice area, or increased transvalvular gradient. A multidetector CT scan allows the dynamic assessment of valves and ruling out fibrosis vs. thrombosis. …
Should We Treat Stroke Percutaneously in TAVR?
Since its inception, transcatheter aortic valve replacement (TAVR) has improved greatly. However, there still are five big challenges to be solved: paravalvular leak, conduction disturbances, debilitating stroke, impaired kidney function, and major vascular complications and bleeding. Most cases of stroke are periprocedural and ischemic. So far, they have not been well analyzed in terms of…
Can We Discharge TAVR Patients the Same Day?
For over a decade, TAVR has been showing great benefits, but conduction abnormalities such as RBBB and prior A-V block, continue to be one of the biggest challenges, since in different series the need for definite pacemaker implantation (PPM) varies between 17 to 30% in the large, randomized studies of self-expanding valves. Even though we…
TAVR in Bicuspid Patients: Are Outcomes the Same in Men and Women?
Bicuspid aortic valve stenosis (BAV) has not yet been analyzed in large, randomized studies, and TAVR in this scenario has been assessed only by small fairly studies. However, the information available is quite promising. TAVR in women generally presents more complications than in men, but severe bicuspid aortic valve stenosis receiving TAVR has not been…
Balloon expandable vs Self-Expanding Valves: The Best Option for ViV-TAVR in Small Annuli
TAVR has consolidated as an increasingly valid alternative to treat failed surgical aortic valve bioprostheses. One of the major challenges it presents is patients with small annuli treated with a surgical bioprosthesis. There is little data available about this scenario. A few observational studies have shown what appears to be a hemodynamic advantage of…