This new consensus published this week in J Am Coll Cardiol has provided us with an algorithm to manage conduction disturbances after transcatheter aortic valve replacement. This consensus is intended to reduce potential deaths caused by conduction disturbances and, at the same time, reduce unnecessary definite pacemaker implantation. This document is a big step ahead…
Physiological and Clinical Changes After Tricuspid Repair
After the recent announcement by the US Food and Drug Administration (FDA) green-lighting transcatheter aortic valve replacement (TAVR) in patients across the whole spectrum, and given the advancements regarding devices already in the market (such as MitraClip) and a variety of pulmonary valves, there is only one territory left to conquer: the long forgotten tricuspid…
Impact of Edge to Edge Transcatheter Tricuspid Valve Repair
Reducing tricuspid regurgitation with transcatheter valve repair is associated to improved liver function, which is often ignored by many cardiologists. This is especially true in cases with deteriorated liver function prior valve repair. Instead, kidney function did not show any changes. Transcatheter tricuspid valve repair seems attractive especially in patients with liver failure. Edge to…
Surgery to Improve Survival in Isolated Tricuspid Regurgitation
Patients with isolated tricuspid regurgitation (i.e., who have no associated left-sided valve disease) are frequently treated conservatively. In many cases, valve disease is highly symptomatic, even with the optimization of medical treatment; however, an invasive strategy is seldom proposed. The aim of this work was to measure the impact of surgery on isolated tricuspid regurgitation…
FDA Expands TAVR Indication to Low-Risk Patients
Both the self-expandable valve Evolut R and its direct competitor, balloon-expandable valve Sapien 3, received the authorization to be indicated for low-risk patients in a long-awaited announcement made on August 16th, 2019. The US Food and Drug Administration (FDA) has approved and expanded the indication for the Evolut series (Medtronic) and the Sapien 3 and…
Loss in Life Expectancy after Surgical Aortic Valve Replacement
This study found after surgical aortic valve replacement (SAVR) patients had shorter life expectancy, compared against the general population. This loss in life expectancy was significant, especially in young patients. These results provide essential information to advice patients before and after SAVR. This is an observational national cohort study to assess long term relative survival…
Clinical Implications of the New Hypertension Guidelines
Hypertension is the first modifiable risk factor affecting morbidity and mortality in nearly half of the adults in the US. The new ACC/AHA guidelines have issued new standards for the detection assessment and management of high blood pressure. The major change compared against their prior version was stage 1 hypertension definition, defined as systolic blood…
New Promising Alternatives for Mitral Regurgitation
PASCAL transcatheter valve repair system for mitral regurgitation has shown feasibility and safety to treat patients with grade 3+ or 4+, regardless etiology. Regurgitation grade was significantly reduced, and this was accompanied by clinical improvement in functional class, exercise capacity and quality of life. This study soon to be published in J Am Coll Cardiol…
Next-Day Discharge after TAVR: Equally Safe for All Prosthesis?
Yet scarce, there is evidence supporting next-day discharge (NDD) after TAVR is safe when patients receiving balloon expandable valves meet certain conditions. This had not yet been shown for self-expandable valves. This study looks into NDD after TAVR by femoral access with self-expandable valves. The authors retrospectively compared all consecutive patients undergoing elective minimalist TAVR…
Valve-in-Valve with Self-Expanding Prosthesis: What Happens with Gradients at One Year?
Degenerated surgical bioprostheses can be safely treated with CoreValve or CoreValve Evolut using the valve-in-valve procedure. Excellent 1-year clinical and hemodynamic outcomes were achieved in a non-selected regular population, i.e., “real-world” patients. The VIVA (Valve in Valve) registry, conducted at 23 sites, was a prospective study designed to systematically collect data from patients with degenerated…
Pulmonary Hypertension: No Reason for TAVR Contraindication
In most severe aortic stenosis patients with pulmonary hypertension, transcatheter aortic valve replacement (TAVR) reduced pulmonary systolic pressure. There patients presented lower risk and lower all-cause mortality at short, median and long term. This data show that pulmonary hypertension should not be a TAVR contraindication. Pulmonary hypertension is common among TAVR patients. The most frequent…