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,…
TCT 2018 | PORTICO-I: One Year Follow-Up for the Self-Expandable Reposisionable Valve
This study was simultaneously presented at TCT and published at JACCE, and it aims at showing the one-year outcomes of this new TAVR device, though follow-up is at 5 years. Primary end point was all cause mortality and secondary end points included clinical and echocardiographic events. With a total 941 patients (82,4 ± 5,9…
TCT 2018 | NEOPRO: A Registry for Acurate neo and Evolut PRO
The purpose of this registry was to compare short-term clinical events and echocardiographic findings in two self-expanding valves used with transfemoral access, Acurate neo and Evolut PRO. The registry included a retrospective follow-up of 1551 patients, among whom 1263 received an Acurate neo valve and 288 received an Evolut Pro valve. The procedural success rates according to VARC-2 criteria were…
TCT 2018 | PARTNER 2 Valve-in-Valve: Clinical and Hemodynamic Results Maintained in the Long Term
The 1-year follow-up for this study was published last year in JACC, and it showed that transcatheter aortic valve replacement (TAVR) in failed bioprosthetic valves has low rates of complications, boosts significant hemodynamic improvement, and results in relatively low mortality. Now, the 3-year results are presented at TCT 2018. The study followed 365 patients who underwent valve-in-valve…
New Atrial Fibrillation After TAVR Indicates Prognosis
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has emerged as an important treatment alternative for intermediate- and high-risk patients. In that sense, the presence of atrial fibrillation (AF) before TAVR is high and it has been associated with worse outcomes and higher mortality. However, there is not much evidence available regarding new-onset atrial…
Mitral Valve Repair in Patients with Cardiac Failure
The mitral valve is a complex apparatus dependent on left atrium and left ventricle functionality. Dilation of these cavities might affect mitral annulus morphology and lead to valve dysfunction, generating mitral regurgitation (MR). This type of MR has been called functional, since leaflets and tendinous chordae do not present lesions themselves; instead, they malfunction ‘secondary’…
Aortic Stenosis with Normal Flow Low Gradient: Should We Intervene or Wait?
Symptomatic patients with <1 cm² aortic valve area will benefit from an intervention regardless parameters such as flow and gradient, even if these are normal (or at least not severe). A valve replacement will be indicated without question (either surgical or percutaneous) in patients with >40 mHg mean gradient or low gradient justified by low…