Transcatheter therapy offers a promise for a largely forgotten valve given the lack of therapeutic options. Percutaneous edge-to-edge repair with clip seems to offer some hope to patients with tricuspid regurgitation according to the TRILUMINATE. At 30 days, transcatheter repair with clip significantly reduced tricuspid regurgitation at least in one grade in most patients, which…
EuroPCR 2019 | COAPT: Mitral Valve Reduction is Associated to Lower Hospitalization and Death
This new analysis shows the mechanism behind the benefit of using MitraClip and the necessary degree of residual mitral regurgitation (MR) to have an impact. Regardless the intervention type, patients with cardiac failure and secondary mitral regurgitation present lower hospitalization for cardiac failure, all-cause mortality and improved quality of life the lower the MR. MitraClip…
EuroPCR 2019 | CHOICE: Balloon-Expandable Valves vs. Self-Expanding Valves in High-Risk Patients
The CHOICE trial included 241 patients with severe aortic stenosis and high surgical risk who underwent transcatheter aortic valve replacement (TAVR) using transfemoral access. These patients were randomized to balloon-expandable valve (Edwards Sapien XT) vs. self-expanding valve (Medtronic CoreValve). The endpoints were all-cause mortality, stroke, readmission, valve function parameters as measured through an ultrasound, and…
TAVR Still Gaining Ground Among Low-Risk Patients
Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis and high surgical risk, and it should be considered as an option for intermediate-risk patients. In recent years, the number of low-risk patients treated with TAVR has increased. This study analyzes low-risk patients from the German Aortic Valve…
MitraClip in the “Real World”
Courtesy of Dr. Carlos Fava. Mitral regurgitation (MR) is the most frequent valvulopathy in Europe and US, affecting close to 10% of patients over 75, with more morbidity and mortality. The treatment of choice is percutaneous repair instead of replacement, to maintain the sub-valvular apparatus that contributes to systole. This is feasible and has better…
The Significance of Aetiology on Mitral Regurgitation
Courtesy of Dr. Carlos Fava. The aetiology of mitral regurgitation (MR) may be divided into primary, organic or degenerative MR, and secondary or functional MR. These two present different physiopathology. The treatment strategy is different for each, and edge-to-edge treatment with Mitraclip is currently emerging as a valid alternative for high-risk patients. This study analyzed 943 patients…
Would TAVR Have a Similar Benefit in Patients with Low Flow, Low Gradient, and Preserved Ejection Fraction?
Courtesy of Dr. Carlos Fava. Patients with low-flow low-gradient severe aortic stenosis are at higher risk, but there is a low-flow low-gradient group with preserved ejection fraction. These patients present systolic and diastolic ventricular dysfunction and their progress is different than that of the high-flow high-gradient normal ventricular function group. This study analyzed 1462 patients. Among them,…
Is Hybrid Operating Room Necessary for Safe TAVR
According to this sub-study of the FRANCE TAVI registry, mortality is similar for transcatheter aortic valve replacement in hybrid operating rooms vs. conventional catheterization labs. These findings support performing TAVR in conventional cath labs, which goes hand in hand with TAVR expansion, with improved logistics and organization costs. This study compared outcomes of patients undergoing…
Promising Results for Tricuspid Repair
Courtesy of Dr. Carlos Fava. Tricuspid regurgitation (TR) is more common than we thought. Around 1.6 million people in the US and over 3 million in Europe experience significant TR. It usually has a functional cause and its negative impact on patient prognosis is strong. Its surgical treatment is challenging, and it is important that its resolution…
Lotus Returns with New Strength and the FDA Approval to Compete with Sapien3 and CoreValve Evolut R
After reports of some serious adverse events with first-generation Lotus, the device was pulled off the market—but it was not meant to be left in oblivion. Now, it is back, renewed and with the approval of the United States Food and Drug Administration (FDA), to compete directly with the two market leaders (Sapien and CoreValve),…
TAVR Learning Curve and Volume-Outcomes Relationship Plateau
Every operator keeps track of their cases. Have they reached their potential or are they still learning and improving their technique? After 1000 procedures, can we expect them to have better results than someone that has only done 500? Prior studies have reached conflictive results and consequently the relationship between learning curve and volume-outcomes remains…