aortic stenosis

Cardiac Damage: Should we start to assess it?

Courtesy of Dr. Carlos Fava. The current recommendation for  aortic valve replacement is based on stenosis severity based on valvular criteria (mean transvalvular gradient, peak aortic velocity and valve index area) and the presence of symptoms, in addition to comorbidities, mainly for risk stratification. However, ventricular damage and/or its effect on cardiovascular hemodynamics are not regarded<a href="https://solaci.org/en/2017/12/20/cardiac-damage-should-we-start-to-assess-it/" title="Read more" >...</a>

valve_in_valve-compressor

Failing Surgical Bioprosthesis: A Challenge on the Rise

Courtesy of Dr. Carlos Fava. The gold standard for failing aortic bioprosthesis has traditionally been surgery. However, since the first valve in valve (TAV-in-SAV) report in 2007, by Wenaweser, transcatheter valve implantation has emerged as a valid alternative. Even so, at present there is not enough scientific evidence in this regard. The present study analyzed<a href="https://solaci.org/en/2017/12/15/failing-surgical-bioprosthesis-a-challenge-on-the-rise/" title="Read more" >...</a>

Enfermedad pulmonar y TAVI, solo se beneficia un grupo reducido de pacientes

Lung Disease and TAVR: Beneficial for a Reduced Group of Patients

Chronic Lung Disease&nbsp;often affects patients with severe aortic stenosis&nbsp;undergoing transcatheter aortic valve replacement (TAVR) or surgery. In fact, this is why patients with lung disease are often deemed inoperable and prescribed TAVR. This is the first time the benefit of TAVR has been assessed in this group of patients, for symptoms of these conditions can<a href="https://solaci.org/en/2017/11/21/lung-disease-and-tavr-beneficial-for-a-reduced-group-of-patients/" title="Read more" >...</a>

Nuevo estudio confirma la durabilidad del TAVI a 5 años

New Study Confirms TAVR Durability at 5 Years

The ADVANCE study was designed to evaluate the safety and effectiveness of transcatheter aortic valve replacement (TAVR) with self-expanding prosthesis CoreValve in “real world” patients with symptomatic, severe aortic stenosis at high surgical risk. Patients were enrolled from 44&nbsp;experimental centers in 12&nbsp;countries; treatment approach and choice of anaesthesia were determined by the local Heart Team.<a href="https://solaci.org/en/2017/10/25/new-study-confirms-tavr-durability-at-5-years/" title="Read more" >...</a>

Cirugía para mejorar la sobrevida en insuficiencia tricuspidea aislada

Tricuspid and Bicuspid Valves Present More Coincidences Than Expected

There is more and more positive evidence that new-generation transcatheter valves, originally designed to treat tricuspid aortic valves, work perfectly fine on bicuspid aortic valves. A comparison of computerized tomography (CT) scans obtained before and after the procedure showed that the most commonly used devices appear to reshape the aortic annulus to the same degree<a href="https://solaci.org/en/2017/10/13/tricuspid-and-bicuspid-valves-present-more-coincidences-than-expected/" 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&nbsp;Evolut R, as well as its predecessor the CoreValve, is a self-expandable&nbsp;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. &nbsp; 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>

El deterioro de las válvulas por catéter es raro y no debería impedir el avance a poblaciones más jóvenes

Valve Deterioration after TAVI Is Rare and Should Not Prevent Advancement to Younger Populations

Durability ─or better yet, lack of deterioration─ is still a matter of debate when considering transcatheter aortic valve intervention&nbsp;(TAVI), especially now that it is being explored as a real alternative for younger patients. A recently published meta-analysis offers more evidence and suggests TAVI deterioration is mostly rare within the first 5 years. &nbsp; According to<a href="https://solaci.org/en/2017/08/14/valve-deterioration-after-tavi-is-rare-and-should-not-prevent-advancement-to-younger-populations/" title="Read more" >...</a>

Doble antiagregación en TAVI, simple es mejor?

Dual Antiplatelet in TAVR: Is Single Better?

Courtesy of Dr. Agustín Vecchia. As TAVR&nbsp;is expanded to lower risk patients, complications become more relevant. As regards stroke, the PARTNER 2 and SURTAVI one year outcomes are 8.0% and 8.2% respectively. The mechanisms behind this complication have not yet been clarified and, therefore, neither have guideline recommendations in this regard (as we can tell<a href="https://solaci.org/en/2017/08/02/dual-antiplatelet-in-tavr-is-single-better/" title="Read more" >...</a>

El reemplazo transcatéter en válvulas bicúspides suma evidencia pero continúan los desafíos

Transcatheter valve replacement in the bicuspid valve is increasingly performed, but challenges remain

As experience increases,&nbsp;transcatheter aortic valve replacement (TAVR)&nbsp;has expanded to different populations and anatomies. This study sought to compare technical and clinical outcomes in patients with bicuspid versus tricuspid aortic stenosis from the&nbsp;Bicuspid AS TAVR Multicenter Registry. &nbsp; Outcomes of 561&nbsp;patients with bicuspid valves and 4546&nbsp;patients with tricuspid valves were compared. Propensity score matching was used<a href="https://solaci.org/en/2017/07/05/transcatheter-valve-replacement-in-the-bicuspid-valve-is-increasingly-performed-but-challenges-remain/" title="Read more" >...</a>

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