Courtesy of Dr. Carlos Fava. Tricuspid regurgitation (TR) is more common than we thought. Around 1.6 million people in the US and over 3 million in Europe experience significant TR. It usually has a functional cause and its negative impact on patient prognosis is strong. Its surgical treatment is challenging, and it is important that its resolution<a href="https://solaci.org/en/2019/05/03/promising-results-for-tricuspid-repair/" title="Read more" >...</a>
After reports of some serious adverse events with first-generation Lotus, the device was pulled off the market—but it was not meant to be left in oblivion. Now, it is back, renewed and with the approval of the United States Food and Drug Administration (FDA), to compete directly with the two market leaders (Sapien and CoreValve),<a href="https://solaci.org/en/2019/04/29/lotus-returns-with-new-strength-and-the-fda-approval-to-compete-with-sapien3-and-corevalve-evolut-r/" title="Read more" >...</a>
Transcatheter mitral valve repair (TMVR) with MitraClip was shown feasible and safe, and therefore a viable option for symptomatic patients with severe mitral valve regurgitation of prohibitive risk. In this regard, the procedure alleviates symptoms, cardiac regurgitation and has a potential benefit on ventricular remodeling. However, many patients presented atrial fibrillation (AF) and mitral valve<a href="https://solaci.org/en/2019/04/10/mitral-valve-repair-with-mirtaclip-was-feasible-and-safe/" title="Read more" >...</a>
Surgical risk scores cannot be used for transcatheter aortic valve replacement (TAVR) and they usually overestimate procedural risk. There are 5 big complications after TAVR, specifically, that cannot be predicted by conventional surgical scores. These 5 peri-procedural complications are considered important because they have a somewhat significant impact on survival after TAVR. They are: 1)<a href="https://solaci.org/en/2019/04/01/we-must-still-fear-the-big-five-complications-after-tavr/" title="Read more" >...</a>
Experts still won’t agree on whether to carry out randomized trial to put an end to this discussion, but it seems clear that balloon expandable TAVR is valid only for certain anatomies. TAVR in real world bicuspid valve populations is associated with similar outcomes at 30 days and one year when compared against cohorts<a href="https://solaci.org/en/2019/03/22/acc-2019-tavr-in-bicuspids-is-safe-and-feasible-in-real-world-patients/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. TAVR has largely been shown superior or non-inferior in high or intermediate risk patients. Indeed, the development of new technologies, the more simplified procedure and the increased experience of operators and team have allowed these groups to benefit from this strategy. However, there is little evidence available on low risk<a href="https://solaci.org/en/2019/03/19/acc-2019-partner-3-low-risk-tavr-vs-surgery-fewer-events-per-year/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. Self-expanding supraannular aortic valves have proved to be superior to surgery in high-risk patients and noninferior in intermediate-risk patients. However, the current challenge is posed by low-risk, generally younger, patients. In that sense, our purpose is to determine device effectiveness and safety in terms of mortality and stroke rates (which are<a href="https://solaci.org/en/2019/03/19/acc-2019-tavr-in-low-risk-patients-is-noninferior/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. At present, the transfemoral is the preferred access site in TAVR, for it has been shown to present fewer complications. However, whenever not feasible, we can resort to other approaches. These include the subclavian, the transapical, the transcaval, the transaortic, and the transcarotid. This last one has been studied few<a href="https://solaci.org/en/2019/03/15/transcarotid-approach-for-transfemoral-in-tavr/" title="Read more" >...</a>
Troponin elevation is a common finding in acute patients admitted by an emergency service, even in the absence of an acute coronary event. There are patients in whom we simply cannot identify the origin of such troponin elevation. Initially, we relied on this marker as an exclusive marker of acute coronary syndrome. In consequence, many<a href="https://solaci.org/en/2019/01/21/troponinitis-or-troponinemia-terms-that-trivialize-troponin-elevation-without-a-specified-diagnosis/" title="Read more" >...</a>
The degeneration of transcatheter biological valves clearly depends on time and starts with thrombus generation and subsequent histological changes resulting in valve failure (due to regurgitation, stenosis, or both). Thrombus formation is the first change, observed early in computerized tomography (CT) scans after implantation. Most times it is completely asymptomatic, which leaves many of us<a href="https://solaci.org/en/2019/01/18/the-physiopathology-behind-valve-degeneration-in-tavr/" title="Read more" >...</a>