As we gradually consolidate the information on the duration of transcatheter aortic valve replacement (TAVR) the focus seems to be moving towards the feasibility of repeat TAVR. How long the valve will last no longer matters as much as how feasible a new procedure is. The supra-annular leaflet position and tall stent frame of the…
Transfusion in TAVR: Caution Is Best
Periprocedural red blood cell transfusion in transcatheter aortic valve replacement (TAVR) correlates with increased mortality and acute kidney injury. It also resulted an independent predictor of 30-day mortality, irrespective of bleeding and vascular complications. The global trend that limits transfusion, in all procedures in general, has finally reached TAVR. The multicenter registry TRITAVI (Transfusion Requirements…
ProGlide vs. Prostar XL to Close Post-TAVR Access
Minimalist transcatheter aortic valve replacement (TAVR) is a strategy that is here to stay. We have previously published papers comparing local vs. general anesthesia, use of transthoracic vs. transesophageal echocardiography, and early discharge in TAVR. In all these papers, the “minimalist approach” included percutaneous closure of vascular access. However, few papers compare closure devices in…
NT-proBNP Level Predicts Who May Benefit From TAVR
A normal or (on the other end) a very high level of NT-proBNP should make us look for a cause other than aortic stenosis. If aortic stenosis is not the culprit of the clinical case, a transcatheter aortic valve replacement (TAVR) will hardly benefit these patients. These data come from a recently published paper in…
Sapien 3 Performs Well in “Jobs” for Which It Is Not Designed
Using Sapien 3, transcatheter mitral valve replacement to treat failed bioprosthetic valves can be performed with a high degree of technical success. Failed mitral bioprosthetic valves are truly challenging due to how frequent symptoms are and the high morbidity/mortality associated with a new surgical replacement. Furthermore, there are no catheter options specifically designed to treat this…
Balloon-Expandable Valve Outdoes Itself
The objective of this paper recently published in J Am Coll Cardiol Intv was to compare the outcomes of transcatheter aortic valve replacement (TAVR) with the new Sapien 3 Ultra vs. Sapien 3. Successful implantation was extremely high with both balloon-expandable devices, which also had a very low adverse event rates. However, Sapien Ultra was significantly better…
AHA 2020 | Post-TAVR Anticoagulation in Patients with Atrial Fibrillation
Direct anticoagulant agents were associated with lower long-term mortality in patients with atrial fibrillation discharged after successful transcatheter aortic valve replacement (TAVR) compared with classic vitamin K inhibitors. Optimal anticoagulation in patients with atrial fibrillation (AF) undergoing TAVR is unclear. We are actually just starting to know what the ideal antiplatelet therapy is for patients undergoing…
AHA 2020 | Rise in Early Discharge After TAVR Has the Expected Cost
As hospitalization time after a transcatheter aortic valve replacement (TAVR) is reduced, we are observing a concomitant increase in re-hospitalizations due to conduction disorders. Early discharge is a great step, but it should be noted that conduction disorders can happen beyond 48 hours. A few years ago, pacemaker implantation rates after discharge were about 7%;…
Asymptomatic Severe Aortic Stenosis, When Should We Intervene?
Data from recent observational randomized studies suggest that most patients with asymptomatic severe aortic stenosis will eventually receive an indication for valve replacement. Mortality in this “asymptomatic” population is caused not only by sudden death, but also by cardiac death. Early intervention may prevent these deaths as a consequence of aortic stenosis symptoms. Researchers…
Conscious Versus General Anesthesia in TAVR
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),…