The edge-to-edge approach with MitraClip has been established as a valid strategy for patients who experience severe symptomatic mitral regurgitation (MI) with high risk for surgery, currently with a IIa indication. MI complicated by cardiogenic shock, which results in a high risk for conventional valve surgery, is a particularly complex scenario. In such a case,...
Should We Treat Obstructive Coronary Artery Disease in TAVI?
Coronary artery disease, both obstructive and non-obstructive, often coexists with significant aortic stenosis. Therapeutic decision-making in this scenario remains controversial, not only regarding the need for treatment, but also about when it should be addressed, considering its pros and cons. Various analyses have yielded contradictory data, as most lesions are chronic and stable. Currently, the...
Does Post-Dilation in TAVR Affect its Long-Term Outcomes?
Transcatheter aortic valve replacement (TAVR) has widely demonstrated its significant benefits, both in high-risk and inoperable patients, as well as in those with intermediate and low risk. While paravalvular regurgitation has been a challenge, its management has improved with operator experience and a deeper understanding of CT angiographies. However, in cases of regurgitation, elevated gradient,...
SAFE-TAVI Study: Safety and Efficacy of the Pressure Sensor and Pacing Guidewire
Currently, we observe an increase in the number of transcatheter aortic valve replacement (TAVR) procedures due to its expansion toward a younger population with lower risk. For this reason, it is crucial to maintain continuous technological innovation to minimize post-procedural complications. The FDA has approved the SavyWire, a preformed 0.035-caliber guidewire that offers three essential...
Predictors of Stroke at 30 Days and 6 Months After TAVR
While the rate of stroke has decreased since the early days of transcatheter aortic valve replacement (TAVR), it remains non-negligible, reaching up to 1%-3% at 30 days. As TAVR progressively expands to low-risk populations and younger patients, identifying risk factors for patient selection and management in stroke prevention becomes crucial. While researchers have identified predictors...
Is TAVR Beneficial in Cardiogenic Shock?
The presence of cardiogenic shock (CS) in a setting of aortic stenosis ranges from 1% to 4%. The prognosis for this scenario is ominous due to subendocardial ischemia, which presents as a decrease in ventricular preload and an increase in afterload. Aortic valvuloplasty has been used in this context, but, unfortunately, it has been associated...
Complex Coronary Angioplasty in Elderly Patients: Problem or Solution?
Cardiovascular disease is the leading cause of death in elderly adults (individuals aged 75 years or older). In turn, coronary heart disease is one of the main causes of morbidity in this population. In addition to anatomical complexities, there are other factors that may complicate its management, such as polypharmacy, frailty, and procedure-related risks. All of...
TAVI-in-TAVI with Balloon-Expandable Valves
TAVI (Transcatheter Aortic Valve Implantation) has proven to be beneficial and is currently performed in increasingly younger and lower-risk patients. However, as with surgical bioprostheses, structural deterioration, whether due to stenosis or regurgitation, is one of the challenges we must address. While currently uncommon, this is an issue we will probably see more and more...
New Devices for Percutaneous Treatment of Native Aortic Regurgitation: Expanding Horizons
Severe aortic regurgitation (AR) may account for 20% to 30% of all surgical aortic valve replacements (SAVR) and is often associated with aortic stenosis (AS). Transcatheter treatment of these patients is limited due to anatomical factors such as root and annular dilation, large annular dimensions, and less calcification in the valve leaflets to serve as...
TAVI in Moderate Aortic Stenosis with Low Ejection Fraction
The presence of aortic stenosis, heart failure, and decreased ventricular function is associated with poor prognosis and high mortality. For this reason, both European and American guidelines classify severe stenosis as a Class I indication. There are two retrospective analyses that demonstrate the benefits of transcatheter aortic valve implantation (TAVI) via transfemoral access. The TAVR...