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<a href="https://solaci.org/en/2019/03/19/acc-2019-tavr-in-low-risk-patients-is-noninferior/" title="Read more" >...</a>
Transcarotid Approach for Transfemoral in TAVR
Courtesy of Dr. Carlos Fava. At present, the transfemoral is the preferred access site in TAVR, for it has been shown to present fewer complications. However, whenever not feasible, we can resort to other approaches. These include the subclavian, the transapical, the transcaval, the transaortic, and the transcarotid. This last one has been studied few<a href="https://solaci.org/en/2019/03/15/transcarotid-approach-for-transfemoral-in-tavr/" title="Read more" >...</a>
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<a href="https://solaci.org/en/2019/03/08/cost-effectiveness-of-tavr-in-intermediate-risk-patients/" title="Read more" >...</a>
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<a href="https://solaci.org/en/2019/02/12/notion-and-uk-tavi-report-good-long-term-outcomes/" title="Read more" >...</a>
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<a href="https://solaci.org/en/2019/01/18/the-most-important-articles-of-2018-in-structural-heart-diseases/" title="Read more" >...</a>
TAVR Is Feasible and Offers Good Outcomes in Patients with Cancer
Courtesy of Dr. Carlos Fava. Oncology patients have been excluded from all studies, but many of them have a life expectancy of over a year or two, and aortic stenosis can pose a problem as regards their treatment. This study analyzed 2744 patients who underwent TAVR. Among them, 222 presented cancer (8.1%). Patients with cancer were younger,<a href="https://solaci.org/en/2019/01/16/tavr-is-feasible-and-offers-good-outcomes-in-patients-with-cancer/" title="Read more" >...</a>
Percutaneous Closure Systems Are Safe in TAVR and Aneurysms
Courtesy of Dr. Carlos Fava. Currently, one of our medical challenges is to conduct procedures requiring access with large introducer sheaths in a simpler way, without requiring surgical intervention and closing with percutaneous devices while maintaining procedural quality and safety. There are several devices, but they require a learning curve and the only information available comes<a href="https://solaci.org/en/2019/01/15/percutaneous-closure-systems-are-safe-in-tavr-and-aneurysms/" title="Read more" >...</a>
Is Individual Operator Experience Important in TAVR?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has emerged as a successful alternative for inoperable patients and a non-inferior alternative for high- and intermediate-risk patients. While its evolution depending on site experience has been analyzed, there is currently very little information regarding the impact of operator individual experience. This study analyzed 8771 procedures performed<a href="https://solaci.org/en/2019/01/09/is-individual-operator-experience-important-in-tavr/" title="Read more" >...</a>
Acute Coronary Syndromes After TAVR: Frequent and Not All Undergo Coronary Angiography
Approximately 10% of patients who undergo transcatheter aortic valve replacement (TAVR) are readmitted for an acute coronary syndrome after a mean follow-up of 25 months. Male sex, prior coronary artery disease, and (surprisingly and hard to explain) nontransfemoral approach were independent predictors of acute coronary syndrome after TAVR, an event associated with high midterm mortality. While<a href="https://solaci.org/en/2019/01/04/acute-coronary-syndromes-after-tavr-frequent-and-not-all-undergo-coronary-angiography/" 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>