Implant depth greater than the length of the membranous septum is an independent predictor of permanent pacemaker implantation. Valve implantation 3 to 5 mm below the aortic annulus in a projection coaxial to the device is recommended. The problem is this is rarely in the annular plane of the valve. Ideal annular plane projection is…
Five-Years After PFO Closure: Procedural Safety and Effectiveness
Five-year outcomes of the randomized REDUCE study showed a continuous benefit from patent foramen ovale (PFO) closure compared with antiplatelet agents to prevent cryptogenic strokes. The most important aspect of this result seems to be the idea that PFO closure in selected patients offers durable benefit with guaranteed long-term safety. The original results from REDUCE…
TAVR in Low-Risk Patients: Though still Superior, with Diminished Advantage after 2 Years.
At two-year followup, primary end point continued to be significantly lower with Sapien 3 vs. conventional surgery, but the initial difference in death and stroke in favor of TAVR started to shrink. In addition, there was higher risk of valve thrombosis in TAVR patients. The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter…
AAS vs Warfarin in Low Risk TAVR
We are still discussing the adequate antithrombotic scheme after transcatheter aortic valve replacement (TAVR). Additionally, we are treating a much wider array of patients ranging from low risk to inoperable. And there is yet one more important point: hypo-attenuated leaflet thickening diagnosed by CT. We are still unaware of the impact they have on device…
Improvements in COAPT Trial for Functional Mitral Regurgitation
Patients with heart failure and moderate-to-severe secondary mitral regurgitation may benefit from transcatheter mitral valve repair. There are benefits at 3 years, even in hard points such as mortality rate. The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial showed fewer heart failure hospitalizations and…
Revascularization Is Needed Before TAVR
Disease prevalence in patients with severe aortic stenosis is highly variable: from 80% in inoperable patients to only 15% according to the most recent research including low-risk patients. Given the high mortality observed in patients with heart disease, guidelines suggest considering coronary bypass revascularization in those in need of a valve replacement. This experience with…
Data that Can Change TAVR and SAVR Strategy
In many relatively young patients with severe aortic stenosis, we rule out the idea of a mechanical valve, opting for a surgical aortic valve replacement (SAVR) with a bioprosthesis; we bet once the surgical bioprosthesis deteriorates, we will be able to solve it with transcatheter aortic valve replacement (TAVR) of the failed surgical valve: TAV-in-SAV. …
Predilation in TAVR and Myocardial Injury
Performing balloon predilation or valvuloplasty before a transcatheter aortic valve replacement (TAVR) may increase the incidence and magnitude of myocardial injury with new-generation balloon-expandable valves. Some papers argue in favor or against direct implantation, others remain neutral, but this research is the first one to express a different point of view. Historically, the biggest fear…
Coronary Access After TAVR: A Potential Problem Ahead
Coronary cannulation after transcatheter aortic valve replacement (TAVR) was unsuccessful in almost 10% of patients. This problem occurred almost exclusively in those who received a self-expanding valve. This study, recently published in JACC Cardiovasc Interv., was sought to investigate the feasibility of coronary ostia access after TAVR and describe potential predictors of coronary access impairment.…
Suture-Based Percutaneous Closure vs. Plug for Large Arteriotomies
This research was designed to test the superiority of plug-based vs. suture-based vascular closure devices in large arteriotomies, such as transcatheter aortic valve replacement (TAVR). Vascular complications from TAVR are relevant and, in many cases, derive from problems with the closure device. The MASH (MANTA vs. Suture-based vascular closure after transcatheter aortic valve replacement) study…
Should We Discontinue Anticoagulation Before TAVR?
Against what common sense dictates, continuing oral anticoagulation pre- and post- transcatheter aortic valve replacement (TAVR) is safe, according to this article soon to be published in JACC Interventions. There was no increase in hemorrhagic or vascular complications and, paradoxically, those who continued using anticoagulant agents received fewer transfusions that those who did not. A…