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...
Cost-Effectiveness of TAVR in Intermediate-Risk Patients
Prior economic analyses had shown that transcatheter aortic valve replacement (TAVR) is cost-effective (which does not mean that it saves money) in high-risk patients compared with surgical replacement. In intermediate-risk patients, this equation was mere speculation until this work recently published in Circulation came along. Physicians started wondering about costs and durability after PARTNER 2 showed...
NOTION and UK TAVI Report Good Long-Term Outcomes
Both studies followed beyond 5 years patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement (TAVR). Findings included low rates of significant valve degeneration and failure, in both cases. While data on the long-term degeneration of transcatheter-implanted valves are scarce, follow-up from the NOTION trial of low-risk patients and from the UK TAVI...
Good Outcomes for MitraClip “Off Label”
Courtesy of Dr. Carlos Fava. Mitral regurgitation is the most frequent type of valve disease, accounting for >6% of patients over 65 years old. Surgery is currently the strategy of choice, but percutaneous treatment is a valid alternative. The long-term progress of symptomatic patients at high surgical risk who do not meet the formal indications for...
The Most Important Articles of 2018 in Structural Heart Diseases
1- ESC 2018 | MITRA FR: Testing MitraClip for Secondary Mitral Regurgitation In secondary mitral regurgitation, mitral-valve leaflets and chordae are structurally normal and mitral regurgitation results from alterations in left ventricular geometry and function. Read more 2- TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation The prognosis of patients with...
The Physiopathology Behind Valve Degeneration in TAVR
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...
More Evidence for the “Forgotten Valve.” Results from the TriValve Registry
Transcatheter tricuspid valve replacement is feasible with different devices, with a reasonable procedural success rate, and is associated with low peri-procedural mortality and significant clinical improvement. Mid-term survival was favorable in this high-risk population. Greater leaflet coaptation depth was associated with reduced procedural success, which, unsurprisingly, turned out to be an independent predictor of mortality....
Continuous Monitoring of Left Atrial Pressure during MitraClip, Regardless Echocardiography
The aim of this study was to assess the use of measuring left atrial pressure to complement transesophageal echocardiography and doppler imaging. Procedure efficacy is measured in the cath lab by echocardiography. However, these measurements are operator dependent and might be influenced by left ventricular function and changes in left atrial compliance. The study...
SOCHICAR@SOLACI Symposium at SOCHICAR 2018 Congress
Within the 55th Chilean Congress of Cardiology and Cardiovascular Surgery, which is taking place in Concepción, Chile, SOLACI held a Joint Session with SOCHICAR on Structural Heart Disease. The moderators for this session were Dr. Mario Araya (Chile), Dr. Eugenio Marchant (Chile), and Dr. Hugo Londero (Argentina). Among the participating lecturers, the presentations by Marcio Montenegro (Percutaneous Treatment of Functional...
TCT 2018 | Mismatch After TAVR According to the TVT Registry
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...