Preventing coronary artery obstruction during transcatheter aortic valve replacement (TAVR) continues to be a challenge. There are techniques to prevent (or at least reduce) this from happening, which could be catastrophic. However, they all somehow fall into palliative care, that is, they will merely provide relief, rather than a cure. Commissure overlapping and the resulting…
Myocardial Fibrosis in Severe Aortic Stenosis: A Matter of Sex?
Courtesy of Dr. Carlos Fava. Aortic valve calcification and its resulting stenosis leads to changes in left ventricle hemodynamics, producing diffuse ischemia followed by inflammation, increased extracellular matrix, necrosis, and later, diffuse fibrosis. At present, with magnetic resonance imaging (MRI) we can analyze ventricular architecture and its function by detecting fibrosis (LGE) and its volume…
In Search of the Optimal Depth for Self-Expandable Valves
Despite the use of the different imaging approaches to calculating implantation depth, optimal depth is reached only 30% of the time. Multiple imaging does not offer a uniform perspective and therefore influence reporting. Basically, we do not have a clear idea of what constitutes optimal depth on a case by case basis and, what is…
Does Surgeon (Instead of Operator) Experience Affect TAVR?
There is a correlation between the volume of conventional surgical aortic valve replacement procedures and better outcomes in transcatheter aortic valve replacement (TAVR), with higher 30-day and 1-year mortality in sites with lower volume. This is a probable indication that a good surgical team is complemented by a good hemodynamic team and, ultimately, a good…
TAVR Long-Term Durability: from the Cath Lab to Real Life
Nominally deployed transcatheter heart valves SAPIEN 3 has shown excellent durability in accelerated testing to an equivalent 25 year-wear. S3 durability resulted comparable to surgical biological valve durability. Non-nominal implants (overexpansion, underexpansion, and elliptical) also showed excellent durability to an equivalent 5 year-wear. The aim of this study was to test nominally deployed S3 durability to 1 billion…
Cerebrovascular Events After TAVR May Be Especially Serious
Stroke events do not seem to be related to valve thrombosis or structural degeneration, but to a higher baseline risk in patients who undergo transcatheter aortic valve replacement (TAVR). About 1 in 20 patients who underwent TAVR experienced a stroke or transient ischemic attack during follow-up. According to this new analysis, the consequences of these events…
TAVR Reaches Low-Risk Patients with Bicuspid Valves
Transcatheter aortic valve replacement (TAVR) seems to be safe in low-risk patients with bicuspid aortic valve stenosis. Their hospital length of stay was very short, with zero mortality, and zero disabling stroke. Subclinical leaflet thrombosis and device durability are still unknown. The United States Food and Drug Administration (FDA) approved TAVR for low-risk patients. However,…
Aortic Valvuloplasty as a Bridge to TAVR: Are We Wasting Our Time?
Doing a balloon aortic valvuloplasty can be a good way to “buy” time before a transcatheter aortic valve replacement (TAVR), according to a registry to be published this week in J Am Coll Cardiol Intv. This study analyzed the database of a whole country to find out the incidence, predictors and outcomes of balloon aortic…
Technological Improvements in Valves Translate into Clinical Results
Three generations of self-expanding valves, three different prognoses for our patients. Design improvements and better materials in self-expanding, supra-annular aortic valves, and their better results, have allowed for the expansion of the indication for transcatheter aortic valve replacement (TAVR). Particularly, the addition of a pericardial skirt improves annular sealing and results in a significantly low…
Predilation in TAVR: Definitive Data for Easier Decision-Making?
Direct implantation (without predilation) resulted non-inferior vs. the conventional strategy with prior balloon aortic valvuloplasty using the S3 prosthesis (even though this did not translate into a simplified procedure). In a few patients, the prosthesis was not able to cross the native valve, which resulted in device retrieval and subsequent valvuloplasty. According to these data,…