Courtesy of Dr. Carlos Fava. Moderate/severe paravalvular regurgitation (PVR) after TAVR is present in 10%-14% of all cases, according to different series. The treatment of choice is post-dilation, generally effective in most cases. However, this strategy carries a risk of stroke. The true impact of this conduct is still unclear. This review analyzed 6 studies that included 5007 patients; 889 of…
Transcatheter valve replacement in the bicuspid valve is increasingly performed, but challenges remain
As experience increases, transcatheter aortic valve replacement (TAVR) has expanded to different populations and anatomies. This study sought to compare technical and clinical outcomes in patients with bicuspid versus tricuspid aortic stenosis from the Bicuspid AS TAVR Multicenter Registry. Outcomes of 561 patients with bicuspid valves and 4546 patients with tricuspid valves were compared. Propensity score matching was used…
Incidence, characteristics, and treatment of valve thrombosis after TAVR
Certain studies have carried out a tomographic follow-up of patients who underwent transcatheter aortic valve replacement (TAVR) and described the frequency of leaflet thrombosis; however, in most cases, it is unclear whether this finding requires some sort of intervention. The difference between this work and those previously published is that this study is not focused on imaging, it…
SENTINEL study: cerebral protection during TAVR
Neurological complications during and after transcatheter aortic valve replacement (TAVR) are probably the only event whose incidence has not been reduced by new valve designs (as opposed to paravalvular leak, vascular complications, or need for pacemaker implantation). Aside from the potential seriousness of this clinical event, the risk of embolism is particularly worrisome because,…
In-hospital morbid-mortality rates for balloon aortic valvuloplasty are similar to those for transcatheter aortic valve implantation
Courtesy of Dr. Carlos Fava. The balloon aortic valvuloplasty (BAV) was introduced by Dr. Cribier in 1986. However, given its poor results, soon after it fell into disuse. With the introduction of TAVR, it saw a revival as bridge for another intervention, even though it is still resisted in many places. The present study…
[SURTAVI] Sub-study of neurological events: more evidence in favor of TAVR
Courtesy of SBHCI. The occurrence of a periprocedural neurological events is associated to an increased risk of death and morbidity at long term, both for transcatheter aortic valve replacement (TAVR) and for surgery. The SURTAVI study, recently presented at the ACC meeting and simultaneously published by NEJM, showed that TAVR with self-expandable CoreValve or Evolut…
NOTION: TAVI with low risk at 4 year follow up
Courtesy of the SBHCI. There is little data about the use of transcatheter aortic valve replacement (TAVR) to treat patients with severe aortic stenosis at low surgical risk. Many of the questions involve long term duration of valves (over 10 years) when treating younger patients with longer life expectancy. The NOTION study aims at comparing…
VIVA Post-Market Study: More Evidence for the Valve-in-Valve Technique
Courtesy of the SBHCI. Bioprosthetic surgically-implanted valves degenerate over time, while patients become too old and are at high risk for reoperation. Transcatheter aortic valve implantation inside a deteriorated surgically-implanted valve (a valve-in-valve procedure) is an emerging alternative. The VIVA trial was designed to offer systematic and prospective data from patients treated with…
Mitral Valve Global Registry: transcatheter mitral valve replacement due to native valve disease
Courtesy of the SBHCI. The risk of surgical mitral valve replacement in patients with significant annular calcification is very high. There are isolated reports of transcatheter mitral valve replacement with balloon-expandable valve in this patient population. In consequence, this multicenter registry tries to concentrate information and analyzes the outcomes a year after the procedure. …
Cerebral protection during TAVI still offers weak evidence, but there is hope
Silent ischemic embolic lesions are common after transcatheter aortic valve implantation (TAVI). The use of cerebral protection devices might reduce the occurrence of these embolic lesions. Multiple studies with different devices, designs, and outcomes challenge the usefulness of cerebral protection during TAVI. A comprehensive analysis of the literature was necessary to obtain a more…
Moderate Aortic Stenosis and Ventricular Dysfunction: Should Valve Replacement Come Sooner?
Ventricular dysfunction and moderate aortic stenosis are more frequent with advancing age and often coexist. Afterload reduction is one of the main pillars of pharmacological treatment of heart failure, and aortic stenosis (even that of moderate severity) increases the afterload. Nowadays, aortic valve replacement is only formally indicated for symptomatic severe aortic stenosis. This…