For interventional cardiologists, treating an ST-segment elevation infarction in a patient with transcatheter aortic valve replacement (TAVR) is challenging in many ways. Longer door-to-balloon times and higher rates of primary angioplasty failure than in the general population are translated into very high short- and mid-term mortality. This multicenter study, recently published in JACC, included 118 patients…
SOLVE-TAVI after 12-month followup: self-expanding vs. balloon expandable and general vs. local anesthesia
The ambitious SOLVE-TAVI (soon to be published in JACC) is aimed at answering to of the most important questions we make when facing a TAVR procedure: What valve do we choose, a self-expanding or a balloon expandable? And once we have chosen our device, do we proceed with general anesthesia or conscious sedation? The…
Incidence, Predictors, and Results of Acute Kidney Injury in Patients Undergoing TAVR
Acute kidney injury after transcatheter aortic valve replacement (TAVR) is a well-known adverse event for all interventional cardiologists. However, it has been understudied: only small observational research has been conducted, showing too wide incidence rates. This research included all patients who underwent TAVR in the USA between 2016 and 2018, totaling over 100,000 patients. All subjects…
Dual Antiplatelet Therapy and TAVR: Obsolete Guidelines
The current guidelines recommend dual antiplatelet therapy (DAPT) 3 to 6 months after transcatheter aortic valve replacement (TAVI). Some recent data finally condensed in the present meta-analysis and recently published in JAHA happen to challenge these guidelines. Clinical studies that investigated single antiplatelet therapy versus DAPT until November 2020 were analyzed and divided according to…
Cerebral Protection Devices during TAVR in the Daily Practice
The theory behind the use of cerebral protection devices during TAVR is good, but hard to test. The daily practice provides a far bigger number of patients, and therefore might be able to better show how to prevent one of the hardest events during TAVR. This study resorted to Germany’s TAVR database between 2015 and…
TAVR vs. the Least Invasive Surgically Implanted Valve
Rapid-deployment surgically implanted valves are designed to make a surgeons’ job faster and easier, compared with conventional bioprostheses, which require several stitches. These valves, which shorten surgical times, could compete with transcatheter-implanted valves (transcatheter aortic valve replacement, TAVR). The German Aortic Valve Registry analyzed 16,473 patients who underwent surgical aortic valve replacement with either a current-generation…
SCOPE I: Acurate NEO vs Sapien 3, no non-inferiority at one year?
The randomized controlled study SCOPE 1 failed to show significant differences at one year between the self-expandable Acurate neo and the balloon expandable Sapien 3. The SCOPE 1 (Safety and Efficacy of the Symetis ACURATE neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis) compared the balloon expandable Sapien 3 (which has probably more data) against…
Surgeons’ Claim on Low-Risk Patients with Aortic Stenosis
Recent randomized trials including low-risk patients showed positive results for transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement. However, surgeons argue that these cases fail to consider patients from daily clinical practice, but rather include a population that has been carefully selected for randomized trials. Patients with non-tricuspid aortic stenosis, with severe…
High Deployment: Also Trending with Balloon Expandable Valves
Conventional implantation of balloon expandable SAPIEN-3 results in a final 70:30 or 80:20 ratio of the valve in the aorta/left ventricular outflow tract. This comes with permanent pacemaker implantation rates of approximately 10%. Higher deployment might translate into lower rates of conduction abnormalities and pacemaker implantation. The study compared a cohort of 1028 consecutive patients; 406…