ATC sobre arterias nativas o puentes venosos, ¿cuál tiene mejor pronóstico?

PCI on Native Arteries or Saphenous Vein Grafts: Which Has Better Prognosis?

New revascularization after coronary artery bypass graft (CABG) is often needed, be it because of severe bridge lesion, intimal hyperplasia, thrombosis, atherosclerosis, or native vessel lesion progression. We therefore need to determine the best revascularization strategy, namely native or graft percutaneous intervention, venous or arterial, or repeat surgery, with the risk it entails.  There is<a href="https://solaci.org/en/2022/06/21/pci-on-native-arteries-or-saphenous-vein-grafts-which-has-better-prognosis/" title="Read more" >...</a>

El aumento de la experiencia de los operadores mejora los resultados en el TAVI

ST-Segment Elevation Infarction After TAVR: Problems in Every Aspect

For interventional cardiologists, treating an ST-segment elevation infarction in a patient with transcatheter aortic valve replacement (TAVR) is challenging in many ways. Longer door-to-balloon times and higher rates of primary angioplasty failure than in the general population are translated into very high short- and mid-term mortality. This multicenter study, recently published in JACC, included 118 patients<a href="https://solaci.org/en/2021/05/10/st-segment-elevation-infarction-after-tavr-problems-in-every-aspect/" title="Read more" >...</a>

TAVR in Low-Risk Patients: Though still Superior, with Diminished Advantage after 2 Years.

At two-year followup, primary end point continued to be significantly lower with Sapien 3 vs. conventional surgery, but the initial difference in death and stroke in favor of TAVR started to shrink.  In addition, there was higher risk of valve thrombosis in TAVR patients.  The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter<a href="https://solaci.org/en/2021/03/16/tavr-in-low-risk-patients-though-still-superior-with-diminished-advantage-after-2-years/" title="Read more" >...</a>

Should We Discontinue Anticoagulation Before TAVR?

Against what common sense dictates, continuing oral anticoagulation pre- and post- transcatheter aortic valve replacement (TAVR) is safe, according to this article soon to be published in JACC Interventions. There was no increase in hemorrhagic or vascular complications and, paradoxically, those who continued using anticoagulant agents received fewer transfusions that those who did not. A<a href="https://solaci.org/en/2021/02/02/should-we-discontinue-anticoagulation-before-tavr/" title="Read more" >...</a>

Debemos tener en cuenta a la isquemia crítica de MM II en el TAVI

Pre-TAVR Revascularization: Angiographic or Physiological?

In patients undergoing transcatheter aortic valve replacement (TAVR), fractional flow reserve (FFR) guided revascularization is associated with favorable results compared against the traditional angiography guided revascularization.  Given the complete lack of randomized studies, this observational study is the best we have to decide how to guide revascularization in patients with symptomatic severe aortic stenosis undergoing<a href="https://solaci.org/en/2019/11/28/pre-tavr-revascularization-angiographic-or-physiological/" title="Read more" >...</a>

Is TAVR at Hospitals Without Backup Cardiovascular Surgery Feasible?

Patients undergoing transcatheter aortic valve replacement (TAVR) at hospitals without cardiovascular surgery available are at significantly higher risk. That in itself is a call for attention; however, a propensity-matched analysis shows that the short- and long-term mortality rates are similar among patients treated at hospitals with and without cardiovascular surgery backup. This debate emerged a<a href="https://solaci.org/en/2018/12/03/is-tavr-at-hospitals-without-backup-cardiovascular-surgery-feasible/" title="Read more" >...</a>

Se publicaron los resultados del estudio RESPECT con excelentes novedades

Liver Failure as a Challenge for TAVR

Although surgical risk scores do not include liver failure (LF), patients who suffer from it and undergo cardiovascular surgery present high rates of morbidity and mortality. This is due to alteration of cardiac function, increased infection susceptibility, gastrointestinal complications, and increased bleeding. As regards transcatheter aortic valve replacement (TAVR), these patients have not been included<a href="https://solaci.org/en/2018/05/03/liver-failure-as-a-challenge-for-tavr/" title="Read more" >...</a>

Critical Lower Limb Ischemia Should Be Taken into Account in TAVR

Courtesy of Dr. Carlos Fava. Peripheral vascular diseases (PVD) present the same risk factors as aortic stenosis. In consequence, these disorders usually coexist. The frequency and impact of their various stages on patients undergoing TAVR is yet to be thoroughly assessed. Read also: “Peripheral Vascular Disease Is Associated to More Events in TAVR”. This study analyzed<a href="https://solaci.org/en/2018/01/15/critical-lower-limb-ischemia-should-be-taken-into-account-in-tavr/" title="Read more" >...</a>

Increasing operator experience improves TAVR outcomes

The introduction of transcatheter aortic valve replacement (TAVR) into clinical practice in the United States has been a tightly controlled process aimed at optimizing patient outcomes and minimizing the learning curve. Many strategies have been used to reach a rational dispersion for this new technology, including choosing sites with enough volume, and adequate operator training<a href="https://solaci.org/en/2017/07/26/increasing-operator-experience-improves-tavr-outcomes/" title="Read more" >...</a>

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