Patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) can safely undergo the procedure under conscious sedation. Conscious sedation has been adopted in clinical practice as a natural way of simplifying and conducting the procedure in the least invasive way possible. Currently, up to 50% of patients undergo TAVR under conscious sedation, but…
Post TAVR ASA Monotherapy Consolidates
This meta-analysis to be published in J Am Cardiol supports the use of aspirin monotherapy (ASA) after transcatheter aortic valve replacement (TAVR). The use of aspirin alone is associated to less bleeding without increased ischemic events such as strokes or mortality. The combined outcomes of four studies, including the recently published POPular TAVI (cohort A),…
Minimalist TAVR to the Max
Transcatheter aortic valve replacement (TAVR) is increasingly being performed under conscious sedation, which is associated with a multi-point benefit (including mortality). This paper, recently published in JACC Intv., shows that general anesthesia is becoming obsolete, although the magnitude the benefit derived from conscious sedation appears to be lower than in previous studies. The aim of…
Size Does Matter for Long Term ViV
The size of the original bioprosthetic valve impacts long term mortality, as does the type of bioprosthetic valve used in percutaneous reinterventions. The number of patients with failed bioprosthesis is on the rise, mainly due to increased life expectancy. Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become more and more common these days and…
TAVR as Anti-Inflammatory? An effect few imagined
We never saw it coming, such a pleiotropic effect: who would have though a mechanical device could have such a systemic anti-inflammatory effect? Transcatheter aortic valve replacement (TAVR) does in fact have it. The shear stress aortic stenosis produces activates multiple inflammatory responses mediated by monocytes. This study identified the most important mechanoreceptor, involved in…
Considerations for Optimal Device Selection in TAVR
Many studies have tried to answer the question about whether there is a superior device in transcatheter aortic valve replacement (TAVR). Today, there is no evidence to support such claim, and most patients will likely find operator experience more beneficial than any device per se. However, there are certain patients with specific characteristics that might…
TAVR After Endocarditis? Contraindication or Last Resort
Transcatheter aortic valve replacement (TAVR) can be an alternative for aortic valves with endocarditis successfully treated with antibiotics, which no longer are severe valve lesions. At one year, the risk of endocarditis relapse was low and the mortality rate was similar to that of patients without a history of infection. This aim of this study…
Outflow Tract Calcification and the Best Valve in This Context
Moderate or severe left ventricle outflow tract calcification increases the risk of annulus rupture, residual aortic regurgitation and the need for a second valve. This recent study analyzed the performance of different contemporary prosthetic valves in patients with this particular anatomy. Since the early days of transcatheter aortic valve replacement (TAVR) outflow tract calcification has…
ESC 2020 | 2020 Atrial Fibrillation Guidelines: News on Diagnosis, Classification, and Care
New guidelines for the diagnosis and treatment of atrial fibrillation (AF) were released at the 2020 European Society of Cardiology (ESC) virtual congress. This document incorporates several findings from the latest clinical trials, but also represents a great shift in terms of how physicians from different specialties should classify and manage arrhythmia after confirming the…
ESC 2020 | New Drug Improves Functional Capacity in Hypertrophic Cardiomyopathy
In patients with hypertrophic cardiomyopathy, myosin inhibitor mavacamten plus optimal medical therapy improved hemodynamics, functional capacity, and symptoms. Mavacamten is the first myosin inhibitor drug of its class. Presented virtually at the European Society of Cardiology 2020 Congress (ESC 2020) and published simultaneously in The Lancet, the EXPLORER-HCM study showed that 37% of patients who received…
3rd Generation Valves in Large and X-Large Annuli
In patients with large and extra-large annuli, transcatheter aortic valve replacement (TAVR) is safe and feasible with 3rd generation valves: the 29mm balloon expandable valve Sapien-3, and their competitor, the self-expandable 34mm Evolut R. The largest size of both devices was designed specifically for patients with large or extra-large annuli. However, one of them seems…