Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has already demonstrated benefit for different risk groups, but one of the remaining challenges is the reduction of the need for a pacemaker, which is still high for self-expanding valves compared with expandable balloons. The study enrolled 203 patients with severe aortic stenosis who underwent TAVR with<a href="https://solaci.org/en/2019/04/12/modern-valves-reduce-the-need-for-a-pacemaker/" title="Read more" >...</a>
The former generation of valves, the balloon expandable (Sapien XT), was associated to less paravalvular leak than the self-expanding valves only in patients with larger annuli. The new generation of self-expanding valves (Evolut R) has managed to significantly improve sealing in patients with larger annuli and still holds potential benefits for smaller annuli. The aim<a href="https://solaci.org/en/2018/12/28/balloon-expandable-vs-self-expanding-to-each-valve-its-own-annulus/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. TAVR has been shown beneficial in high and moderate risk patients, but there is a group of patients that require dialysis on account of kidney deterioration. This comorbidity is due to bad cardiovascular evolution associated to diabetes, bleeding and thromboembolic events. For some time, we have been using an<a href="https://solaci.org/en/2018/12/03/aortic-stenosis-and-dialysis-is-tavr-the-strategy-of-choice/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. We are well aware of transcatheter aortic valve replacement’s (TAVR) effect in high-risk or inoperable patients at 5 years, even more after the PARTNER 1 trial. Yet, the outcomes of another relevant randomized study remained pending: el CoreValve US Pivotal High-Risk Trial. The CoreValve US Pivotal High-Risk Trial looked at the<a href="https://solaci.org/en/2018/11/21/corevalve-us-pivotal-high-risk-trial-at-5-years-similar-results/" title="Read more" >...</a>
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;<a href="https://solaci.org/en/2018/10/30/what-should-we-use-for-the-functional-assessment-of-coronary-lesions-in-severe-aortic-stenosis/" title="Read more" >...</a>
The 1-year follow-up for this study was published last year in JACC, and it showed that transcatheter aortic valve replacement (TAVR) in failed bioprosthetic valves has low rates of complications, boosts significant hemodynamic improvement, and results in relatively low mortality. Now, the 3-year results are presented at TCT 2018. The study followed 365 patients who underwent valve-in-valve<a href="https://solaci.org/en/2018/10/04/tct-2018-partner-2-valve-in-valve-clinical-and-hemodynamic-results-maintained-in-the-long-term/" title="Read more" >...</a>
The idea behind this study is that debris can be captured in all patients during TAVR, even though we still ignore which patients would benefit more from this device. Tissue particles captured by the SENTINEL during TAVR vary from valve to valve, according to this new analysis. There are differences in size and number of<a href="https://solaci.org/en/2018/09/19/debris-captured-by-sentinel-devices-result-different-across-different-valves/" title="Read more" >...</a>
Pressure loss vs. flow curves offer a fundamental synthesis of fluids dynamics in describing aortic valve physiopathology. Severe aortic stenosis is not just an orifice (as suggested by Gorlin) or a segment that offers dynamic resistance. However, once a new transcatheter valve has been implanted, it will behave purely as a resistor. At dobutamine dose,<a href="https://solaci.org/en/2018/08/15/gradient-vs-flow-to-determine-aortic-valve-stenosis-severity-before-and-after-tavr/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) was developed for aortic stenosis, but there is a significant number of patients with severe aortic regurgitation who still undergo this procedure as an off-label indication. Current evidence for this procedure in relation with this disease is growing, mainly due to good results obtained by different<a href="https://solaci.org/en/2018/07/27/more-favorable-evidence-for-tavr-in-severe-aortic-regurgitation/" title="Read more" >...</a>
During valve replacement, cerebral protection systems may capture debris in up to 99% of all patients. In over half of them, these particles are >1 mm. The particles captured during procedures in which Evolut R or Lotus valves were used were more and larger compared with those captured with the Sapien balloon-expandable valve. Beyond differences among valves,<a href="https://solaci.org/en/2018/07/06/differences-in-debris-captured-according-to-valve-type/" title="Read more" >...</a>