Pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) should not preclude this procedure. In fact, TAVR will resolve this condition in most cases. More than three quarters of patients undergoing TAVR have some level of PH, though this has not been associated to increased mortality, according to this<a href="https://solaci.org/en/2018/05/04/baseline-pulmonary-hypertension-should-not-preclude-tavr/" title="Read more" >...</a>
The benefits of transcatheter aortic valve replacement (TAVR) for high-risk, prohibitive-risk (class I) or intermediate-risk (class IIa) patients have already been proven, but there is a growing population of patients with a history of myocardial revascularization surgery (MRS) who experience severe aortic stenosis. Decision-making in these cases is anything but simple, mainly due to the presence of<a href="https://solaci.org/en/2018/05/02/tavr-with-prior-mrs-a-new-challenge/" title="Read more" >...</a>
Classical symptomatic low-flow, low-gradient (LFLG) severe aortic stenosis is associated with low survival rates at 3 years (<50%). However, in the medium term and with surgery, those rates improve (although mortality rates are 6%-30%, depending on the series). In patients without contractile reserve, surgical mortality is higher. Patient evolution in TAVR is still mostly unclear. <a href="https://solaci.org/en/2018/04/12/tavr-in-patients-with-classical-low-flow-low-gradient/" title="Read more" >...</a>
Aortic stenosis increases afterload creating hypertrophy as a compensation mechanism to maintain minute volume. This leads to left ventricular diastolic dysfunction (LVDD). More than half of patients presenting aortic stenosis have LVDD and myocardial fibrosis, which is a mortality predictor in surgery. At present, there is contradicting evidence in TAVR. The study looked<a href="https://solaci.org/en/2018/04/12/diastolic-dysfunction-should-be-considered-in-tavr/" title="Read more" >...</a>
A mean gradient ≥40 mmHg, an aortic valve area ≤1 cm², or a combination of both, during dobutamine stress echocardiography, correctly qualifies as severe aortic stenosis in about half of all patients. The other half consists in cases of pseudo-severe aortic stenosis. In turn, a projected aortic valve area ≤1 cm² is a much better indicator than the<a href="https://solaci.org/en/2018/04/09/which-low-flow-low-gradient-patients-benefit-from-valve-replacement/" title="Read more" >...</a>
After aortic valve replacement, focal fibrosis does not resolve, but diffuse fibrosis and cell hypertrophy regress. As expected, this regression comes with structural and functional improvement that suggest it is a dynamic process. Fibrosis can be measured and quantified with cardiovascular MR, which makes it a potential therapeutic objective. Left ventricular hypertrophy is a key<a href="https://solaci.org/en/2018/04/08/reverse-myocardial-remodeling-following-valve-replacement/" title="Read more" >...</a>
A new study raises an alarm against expanding transcatheter aortic valve replacement (TAVR) procedures to low surgical risk patients, since 2 year mortality seems higher in these patients with TAVR, compared to conventional surgery. This study will soon be published in Catheter Cardiovasc Interv. Expanding TAVR to low risk patients might involve risks we have not<a href="https://solaci.org/en/2018/03/14/red-light-for-tavr-in-low-surgical-risk-patients/" title="Read more" >...</a>
The association between aortic stenosis and coronary disease is common, since both conditions share pathogenesis, risk factors, and symptoms. Transcatheter aortic valve replacement (TAVR) is currently indicated for high-risk and inoperable patients. It also appears as a valid alternative for the treatment of intermediate-risk patients, and it could soon be indicated for low-risk patients. Coronary<a href="https://solaci.org/en/2018/02/20/coronary-disease-works-as-a-30-day-predictor-in-tavr/" title="Read more" >...</a>
Edwards Lifesciences could have been satisfied after the success of the PARTNER trials and the improvements to its balloon-expandable valve (mainly as regards the delivery system profile and paravalvular leak reduction) in its last model, SAPIEN 3. However, it was not. The company decided to keep going, developing a valve that is radically different from its<a href="https://solaci.org/en/2018/02/19/leading-manufacturer-of-balloon-expandable-valves-launches-self-expanding-device/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. In most randomized or observational studies, women comprise more than 50% of patients undergoing TAVR, and they have showed better evolution, compared against surgery. The main differences between men and women with severe aortic stenosis are that women have smaller annular dimension, shorter distance to coronary ostia, smaller peripheral arteries, and<a href="https://solaci.org/en/2018/01/24/win-tavi-the-largest-female-tavr-registry-so-far/" title="Read more" >...</a>