Despite the benefit for most patients, a small number of patients still show poor outcomes after transcatheter aortic valve implantation (TAVR). This work was able to recalibrate a previously developed risk model to predict post TAVR quality of life and provide us with a potential tool to properly estimate the chances of good recovery, or…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
Galileo: Rivaroxaban After TAVR Stopped Due to Early Event Rates
Patients undergoing transcatheter aortic valve replacement (TAVR) randomized to rivaroxaban in the GALILEO trial experienced higher risk of all-cause death, thromboembolic events, and bleeding compared with patients who received antiplatelet therapy. The GALILEO trial was halted after an early peek of events at the data from the rivaroxaban (Xarelto; Bayer/Janssen) arm. These events included higher…
Immediate Electrocardiography After TAVI, the Simplest Way to Predict Conduction Disorders
Taking into account a simple 12-lead electrocardiography performed immediately after transcatheter aortic valve implantation (TAVI), removing the temporary pacemaker immediately is safe in patients without right bundle branch block who are in sinus rhythm with PR interval <240 ms and QRS interval <150 ms. In cases of atrial fibrillation, a QRS interval <140 ms also reassures the decision…
Ambulatory Continuous Monitoring in Patients with Left Bundle Branch Block After TAVI
The incidence of arrhythmic events up to a year after implantation is high and involves almost half the patients with complete left bundle branch block following the procedure. Significant bradyarrhythmias occur in up to one-fifth of the patients, half of whom ultimately require a pacemaker. These data support the idea of a cardiac monitoring device…
Predictors of Conduction Disturbances Requiring a Late Permanent Pacemaker
This analysis shows that baseline right bundle branch block and increased PR length after transcatheter aortic valve replacement (TAVR) are independent predictors of advanced conduction disturbances requiring late pacemaker implantation. A simple electrocardiography can detect these potentially fatal conduction disturbances that might happen more than 48 hours after TAVR. Data from consecutive TAVR patients from…
TCT 2018 | Mismatch After TAVR According to the TVT Registry
Prosthesis-patient mismatch (i.e. a difference between the size of the implanted prosthetic valve and the patient body size) in patients who undergo surgery is associated with worse outcomes. This may also apply to percutaneous prostheses, although that has not been well-studied yet. This work, presented at TCT 2018 and published simultaneously in JACC, analyzes this problem…
TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation
The prognosis of patients with heart failure and mitral regurgitation secondary to ventricular dysfunction and dilation is guarded. Percutaneous mitral valve treatment of these patients may at least improve their symptoms. This study was conducted in 78 sites in the United States and Canada, and included patients with moderate-to-severe (3+) or severe (4+) mitral regurgitation who…
TCT 2018 | TriValve: Mitraclip for the Tricuspid Valve
The TriValve is a multicenter, international and retrospective study of multiple devices for percutaneous intervention to treat cardiac failure. This is a sub-analysis of patients receiving the most conventional of these devices: the MitraClip. The main points assessed by this study were all cause mortality, unplanned hospitalizations, functional class, the presence of peripheral edema, and…
TCT 2018 | SOLVE-TAVI: Self-Expandable vs. Balloon-Expandable Valves and General vs. Local Anesthesia in One Study
This prospective, randomized, multicenter study included 447 patients with severe aortic stenosis and intermediate or high surgical risk randomized in a 2×2 factorial design to general vs. conscious sedation with local anesthesia and also to receiving the Sapien 3 valve (balloon-expandable) vs. CoreValve Evolut R (self-expandable). Primary end point was a composite of all-cause mortality,…
TCT 2018 | REDUCE-FMR: Indirect Annuloplasty in Secondary Mitral Regurgitation
Prior studies such as the AMADEUS, TITAN or TITAN II have shown reduction of mitral valve regurgitation (MR) with the Carillon device. This sham-controlled randomized study tested the efficacy of this device in secondary mitral regurgitation. Primary end point was echocardiographic MR reduction (blind core lab) and secondary end point were hospitalization for cardiac failure,…