Despite the benefit for most patients, a small number of patients still show poor outcomes after transcatheter aortic valve implantation (TAVR). This work was able to recalibrate a previously developed risk model to predict post TAVR quality of life and provide us with a potential tool to properly estimate the chances of good recovery, or...
Patients undergoing transcatheter aortic valve replacement (TAVR) randomized to rivaroxaban in the GALILEO trial experienced higher risk of all-cause death, thromboembolic events, and bleeding compared with patients who received antiplatelet therapy. The GALILEO trial was halted after an early peek of events at the data from the rivaroxaban (Xarelto; Bayer/Janssen) arm. These events included higher...
Prosthesis-patient mismatch (i.e. a difference between the size of the implanted prosthetic valve and the patient body size) in patients who undergo surgery is associated with worse outcomes. This may also apply to percutaneous prostheses, although that has not been well-studied yet. This work, presented at TCT 2018 and published simultaneously in JACC, analyzes this problem...
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has emerged as an important treatment alternative for intermediate- and high-risk patients. In that sense, the presence of atrial fibrillation (AF) before TAVR is high and it has been associated with worse outcomes and higher mortality. However, there is not much evidence available regarding new-onset atrial...
Courtesy of Dr. Carlos Fava. Numerous studies have shown that the presence of aortic regurgitation after TAVR is associated with worse evolution, and that balloon post-dilation (BPD) is the adequate strategy to correct this. However, a few reports using first generation valves have associated BPD to complications such as stroke, annulus rupture and valve displacement,...
Some of the many ongoing randomized studies including patients with atrial fibrillation (AF) might finally answer the question on the best antithrombotic scheme post TAVR. According to this registry, in patients undergoing transcatheter aortic valve replacement, independent predictors of death at 3 years are being a man, having moderate to severe kidney failure, and having...
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,...
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...
Nutritional status is associated with higher mortality in elderly patients with severe aortic stenosis who require valve replacement, whether through conventional surgical strategy or transcatheter aortic valve replacement (TAVR). Malnutrition is obviously associated with frailty. As an advantage, it can be quite evident to our clinical eye and weighing scales are enough to define it....
Courtesy of Dr. Carlos Fava. Aortic stenosis with cardiac failure or cardiogenic shock involves high mortality risk at short term. Surgery in these conditions is often unsafe, which leaves us with valvuloplasty, but only as a bridge to some other procedure, seeing as it is effective only for a short time. Few studies have looked into patients undergoing...