Courtesy of Dr. Carlos Fava. Between 40% and 70% of patients undergoing transcatheter aortic valve replacement (TAVR) present coronary lesions. The fact that aortic stenosis affects how blockages act, and that, after stenosis correction, hemodynamic compromise for those same lesions may vary, has been consistently proven. Its management has not been determined yet. The study…
TAVR in Pure Aortic Insufficiency: Yes or No?
Courtesy of Dr. Agustín Vecchia. Surgery is the treatment of choice for patients with symptomatic aortic insufficiency and/or ventricular dilatation or decreased ventricular function. The broad implementation of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, the emergence of new devices, and the experience acquired by operators have brought this treatment to off-label indications such…
TAVR: Transcarotid Access as a Valid Alternative
Courtesy of Dr. Carlos Fava. Transfemoral access is the first choice for transcatheter aortic valve replacement (TAVR). However, this approach is not feasible for a progressively larger number of patients, which establishes the need to search for alternative accesses. Between 2009 and 2014, this study enrolled 174 patients who underwent TAVR and were unsuitable for transfemoral…
TAVR: Pre-Existing Complete Right Bundle Branch Block Is Associated with Mortality
Courtesy of Dr. Carlos Fava. The fact that the presence of a complete right bundle branch block (RBBB) increases the risk of bradycardia, high-grade atrioventricular block, and need for a permanent pacemaker (PPM) after TAVR is well-known. The impact of pre-existing complete right bundle branch block has not been well-studied. This article analyses 749 patients enrolled in…
Transapical and Transaortic TAVR: Valid Alternatives to the Transfemoral
Courtesy of Dr. Carlos Fava. The femoral approach has been the gold standard for the transcatheter aortic valve replacement procedure (TAVR); however, it is anatomically unsuitable for an important number of patients, and these require a different approach. At present, there is little evidence in support of the transapical or transaortic access sites as…
Local Anesthesia for TAVR Was Safe and Reduced Hospital Stays
A minimalist approach to transcatheter aortic valve replacement (TAVR) involving local anesthesia appears to have several advantages, according to this new meta-analysis. In addition to shortening times for procedures and lengths of stay in the critical care unit and hospital, lighter sedation may lower the need for transfusions or treatment with inotropes or vasopressors.…
TAVR or Surgery for Intermediate-Risk Patients? (GARY Registry)
New findings from the GARY (German Aortic Valve Registry) registry show that intermediate-risk patients with severe aortic stenosis presented significantly higher mortality at 1 year when treated with transcatheter aortic valve replacement (TAVR) rather than with conventional surgery. Results reflect everyday realities, which might include various bias tipping the scales towards one strategy or the…
Less than 20% of patients that could benefit from TAVR are receiving it
The introduction of transcatheter aortic valve replacement procedures (TAVR) seems to have increased the number of elderly patients hospitalized with severe aortic stenosis, as well as the number of interventions. However, less than one fifth of patients over 85 are intervened, according to a Canadian registry. Given the significant difference in mortality with TAVR,…
TAVR: The Need for a Pacemaker Is Associated with Mortality
Courtesy of Dr. Carlos Fava. After a transcatheter aortic valve replacement (TAVR), the incidence of permanent pacemaker (PPM) implantation ranges from 6% to 30% in different studies, depending on the valve type used. This is due to trauma, ischemia, haemorrhage, and atrioventricular node and infranodal tissue oedema, provoking ventricular dyssynchrony similar to that caused by…
Post-TAVI Definite Pacemaker: How Harmless Is It?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has shown ample benefit in different groups, but one of its drawbacks continues to be the need for permanent pacemaker (PPM), which ranges between 5 and 30%. Its long term impact in terms of mortality is still controversial, since some studies associate it with…
Valve Thrombosis After TAVR: Larger-Diameter Valves and No Warfarin as Predictors
There are limited data on the incidence, clinical implications, and predisposing factors of valve thrombosis in patients who underwent transcatheter aortic valve replacement (TAVR). This study aimed at determining such information through multislice computed tomography (CT). This trial included 460 consecutive patients who underwent TAVR with a balloon-expandable Edwards Sapien XT or Sapien 3 (Edwards Lifesciences,…