Polymer-Free DES Also Show Efficacy in Anticoagulated Patients with High Risk for Bleeding

Patients who receive chronic anticoagulation therapy and then undergo angioplasty are frequently discharged on a triple anti-thrombotic scheme that usually includes aspirin, clopidogrel, and warfarin. The optimal duration of this indication remains unclear, particularly for patients at high bleeding risk. According to expert consensus, patients receiving chronic anticoagulation may receive from 1 to 12 months of dual<a href="https://solaci.org/en/2017/09/08/polymer-free-des-also-show-efficacy-in-anticoagulated-patients-with-high-risk-for-bleeding/" title="Read more" >...</a>

COMPASS: un nuevo lugar para el rivaroxaban en cardiopatía isquémica crónica

COMPASS: A New Place for Rivaroxaban in Chronic Ischemic Heart Disease

Combining low doses of rivaroxaban and aspirin seems to be the best strategy for patients with stable chronic ischemic heart disease, according to this new study presented at the European Society of Cardiology Congress 2017, which was published simultaneously in the New England Journal of Medicine. Compared with low-dose aspirin alone, the combination of aspirin<a href="https://solaci.org/en/2017/09/07/compass-a-new-place-for-rivaroxaban-in-chronic-ischemic-heart-disease/" title="Read more" >...</a>

La válvula CoreValve Evolut R arroja resultados positivos en una población importante de pacientes La Evolut R, al igual que su predecesora CoreValve, es una válvula autoexpandible, supra-anular, de pericardio porcino en un stent de nitinol. Entre las mejoras de esta válvula se pueden enumerar su mejor perfil y la posibilidad de re-envainarla. Esto la hace completamente reposicionable e incluso recapturable. Faltaba ver si estas ventajas técnicas se traducirían en ventajas clínicas (lo cual es -en definitiva- lo que importa) en una población grande de pacientes del mundo real. El estudio FORWARD (CoreValve Evolut R FORWARD) es un registro prospectivo que incluyó 1038 pacientes de 53 centros y cuatro continentes. Los pacientes tuvieron una edad media de 81.8 ± 6.2 años y un STS de 5.5 ± 4.5%, lo cual constituye un riesgo intermedio y coincide con la tendencia actual de la práctica clínica. La capacidad de reposicionar la válvula debió ser utilizada en el 25.8% de los pacientes, característica que permitió el implante de una sola válvula en el lugar correcto en el 98.9% de los casos. A 30 días, la mortalidad fue del 1.9% y el stroke incapacitante del 1.8%. Solo el 1.9% de los pacientes presentó insuficiencia aórtica moderada a severa; la tasa de marcapaso definitivo fue del 17.5%. Ambos datos están por debajo de lo que mostró el estudio SURTAVI con la CoreValve en una población similar (3.4% y 25.9% respectivamente) y la mejora se puede atribuir a la posibilidad de reposicionar el dispositivo. Conclusión La nueva generación de la válvula autoexpandible es segura y efectiva en pacientes con estenosis aórtica severa no seleccionados del mundo real. Comentario editorial La mortalidad por cualquier causa del 1.9% está claramente por debajo del 5.5% esperado según el score de STS y en sintonía con la del 1.1% descripta en el registro que testeó la última generación de la válvula balón expandible SAPIEN 3 en una población similar. El 98% de los pacientes fueron tratados por acceso femoral, lo cual también es la tendencia mundial gracias a la significativa disminución del perfil de los dispositivos. Afortunadamente, la enorme mayoría de las mejoras técnicas que han incorporado los nuevos dispositivos (tanto este como la competencia) han logrado traducirse en mejoras clínicas para los pacientes, logrando reducir la insuficiencia paravalvular, la tasa de marcapaso y las complicaciones vasculares. Título original: Clinical Outcomes With a Repositionable Self-Expanding Transcatheter Aortic Valve Prosthesis. The International FORWARD Study. Referencia: Eberhard Grube et al. J Am Coll Cardiol 2017;70:845–53.

Positive Outcomes of CoreValve Evolut in Large Population

The Evolut R, as well as its predecessor the CoreValve, is a self-expandable valve, supra-annular, made of porcine pericardium in a nitinol frame. Amongst its improvements, it has a better profile and the option to resheath. This makes it fully repositionable and even recapturable.   We only needed to confirm these technical advantages would translate into clinical<a href="https://solaci.org/en/2017/08/30/positive-outcomes-of-corevalve-evolut-in-large-population/" title="Read more" >...</a>

Predicción de mortalidad en TAVI - Marcapaso

A Simple Electrocardiography to Predict Mortality in TAVR

Conduction abnormalities, such as new left bundle branch block, atrioventricular block, and need for a pacemaker, are still among the most frequent complications in transcatheter aortic valve replacement (TAVR). New valve generations have (mostly) not managed to reduce significantly electrical abnormalities; furthermore, some modifications such as external skirts, which are extremely effective for the reduction<a href="https://solaci.org/en/2017/08/29/a-simple-electrocardiography-to-predict-mortality-in-tavr/" title="Read more" >...</a>

Lotus vs Sapien 3, mecanismos diferentes con resultados similares

Lotus vs Sapien 3, different mechanisms with similar results

The new generation devices for transfemoral transcatheter aortic valve replacement have been optimized to improve valve position and reduce residual aortic regurgitation.   This study compared 30 day, 12 month and 24 month outcomes of the repositionable, Lotus valve, with controlled mechanical expansion, and the balloon-expandable valve Edwards Sapien 3.   Primary end point was all cause mortality<a href="https://solaci.org/en/2017/07/26/lotus-vs-sapien-3-different-mechanisms-with-similar-results/" title="Read more" >...</a>

CRM vs DES: ¿Cuál se asocia mejor calidad de vida a largo plazo?

MRS vs. DES: Which one is associated with better long-term quality of life?

The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be<a href="https://solaci.org/en/2017/07/21/mrs-vs-des-which-one-is-associated-with-better-long-term-quality-of-life/" title="Read more" >...</a>

NOTION: TAVI with Low Risk at 4 Year Follow Up

Post-dilation in TAVI associated to more stroke and more paravalvular regurgitation

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<a href="https://solaci.org/en/2017/07/10/post-dilation-in-tavi-associated-to-more-stroke-and-more-paravalvular-regurgitation/" title="Read more" >...</a>

Evolución de pacientes jóvenes con miocardiopatía hipertrófica tratados con ablación septal por alcoholización.

Progress of patients with hypertrophic cardiomyopathy treated with alcohol septal ablation

Courtesy of Dr. José Álvarez. Alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy (OHC) is a procedure introduced in 1995 as an alternative to surgical myectomy.   The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines indicate that ASA should be reserved for older patients with comorbidities, thus establishing surgical myectomy<a href="https://solaci.org/en/2017/06/28/progress-of-patients-with-hypertrophic-cardiomyopathy-treated-with-alcohol-septal-ablation/" title="Read more" >...</a>

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,<a href="https://solaci.org/en/2017/06/15/sentinel-study-cerebral-protection-during-tavr/" title="Read more" >...</a>

La Valvuloplastia Aórtica es factible y segura

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<a href="https://solaci.org/en/2017/06/07/in-hospital-morbid-mortality-rates-for-balloon-aortic-valvuloplasty-are-similar-to-those-for-transcatheter-aortic-valve-implantation/" title="Read more" >...</a>