CoreValve

TCT 2020 | Xience se suma a la evidencia de doble antiagregación corta en alto riesgo de sangrado

TCT 2020 | Xience in Favor of Short Dual Antiaggregation Therapy with High Bleeding Risk

Following with aspirin alone after a short period of dual antiaggregation therapy (DAPT), 1 to 3 months, did not increase ischemic events in patients receiving a Xience stent while significantly reducing bleeding.&nbsp; This study endorses the safety of short DAPT with contemporary drug eluting stents (DES) in patients presenting high bleeding risk.&nbsp; The XIENCE Short<a href="https://solaci.org/en/2020/10/21/tct-2020-xience-in-favor-of-short-dual-antiaggregation-therapy-with-high-bleeding-risk/" title="Read more" >...</a>

valve_in_valve

Size Does Matter for Long Term ViV

The size of the original bioprosthetic valve impacts long term mortality, as does the type of bioprosthetic valve used in percutaneous reinterventions.  The number of patients with failed bioprosthesis is on the rise, mainly due to increased life expectancy.  Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become more and more common these days and<a href="https://solaci.org/en/2020/09/29/size-does-matter-for-long-term-viv/" title="Read more" >...</a>

TAVI: Balón expandible o autoexpandible ¿Cuál es la respuesta?

Considerations for Optimal Device Selection in TAVR

Many studies have tried to answer the question about whether there is a superior device in transcatheter aortic valve replacement (TAVR). Today, there is no evidence to support such claim, and most patients will likely find operator experience more beneficial than any device per se.&nbsp;&nbsp; However, there are certain patients with specific characteristics that might<a href="https://solaci.org/en/2020/09/24/considerations-for-optimal-device-selection-in-tavr/" title="Read more" >...</a>

valve_in_valve

Valve-in-Valve: Good Evolution at Long-Term

Courtesy of Dr. Carlos Fava. In the last decades, there has been a marked increase in the use bioprosthetic valves in aortic position given their benefits over mechanical valves. However, long term follow-up has shown structural valve degeneration (SVD). Given the risk of a second surgery after TAVR, valve-in-valve (ViV) has been on the rise,<a href="https://solaci.org/en/2020/08/19/valve-in-valve-good-evolution-at-long-term/" 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.

After 8-year Followup, Good News for the Self Expandable Valve

As the transcatheter aortic valve replacement (TAVR) gains ground in lower risk populations and with better survival rate, concern over its durability has grown.&nbsp; This study brings us data and good news on the first-generation self-expandable valve after quite a long follow up. It included 990 inoperable or high-risk patients treated with CoreValve in 8<a href="https://solaci.org/en/2020/07/22/after-8-year-followup-good-news-for-the-self-expandable-valve/" title="Read more" >...</a>

EuroPCR 2020 | Valve in Valve aórtico a largo plazo

EuroPCR 2020 | Aortic Valve in Valve in the Long Term

The outcomes of this work are important to plan valve replacement with the largest possible prosthesis allowed by patient anatomy in the index procedure. As a worldwide trend, increasingly more patients are receiving bioprostheses, which have improved a lot but still tend to become deteriorated and require a valve-in-valve procedure if the patient is no<a href="https://solaci.org/en/2020/07/13/europcr-2020-aortic-valve-in-valve-in-the-long-term/" title="Read more" >...</a>

TAVI: Balón expandible o autoexpandible ¿Cuál es la respuesta?

TAVR: Balloon-Expandable or Self-Expanding Valves, Which Is the Answer?

Courtesy of Dr. Carlos&nbsp;Fava. Transcatheter aortic valve replacement (TAVR) has shown benefit and is currently moving towards low-risk patients, as well as bicuspid aortic valves and (to a lower extent) aortic regurgitation. However, we must ponder on which valve should be used on each patient: balloon-expandable (BE) or self-expanding (SE) valve? They represent different technologies<a href="https://solaci.org/en/2020/06/03/tavr-balloon-expandable-or-self-expanding-valves-which-is-the-answer/" title="Read more" >...</a>

La angina microvascular podría tener gradientes de riesgo

Aligning Prosthetic Valves to Native Commissures: The Secret to Coronary Artery Obstruction?

Preventing coronary artery obstruction during transcatheter aortic valve replacement (TAVR) continues to be a challenge. There are techniques to prevent (or at least reduce) this from happening, which could be catastrophic. However, they all somehow fall into palliative care, that is, they will merely provide relief, rather than a cure.&nbsp; Commissure overlapping and the resulting<a href="https://solaci.org/en/2020/05/26/aligning-prosthetic-valves-to-native-commisures-secret-to-coronary-artery-obstruction/" title="Read more" >...</a>

Mejoras tecnológicas en las válvulas que se traducen en resultados clínicos

Technological Improvements in Valves Translate into Clinical Results

Three generations of self-expanding valves, three different prognoses for our patients. Design improvements and better materials in self-expanding, supra-annular aortic valves, and their better results, have allowed for the expansion of the indication for transcatheter aortic valve replacement (TAVR). Particularly, the addition of a pericardial skirt improves annular sealing and results in a significantly low<a href="https://solaci.org/en/2020/04/08/technological-improvements-in-valves-translate-into-clinical-results/" title="Read more" >...</a>

AHA 2019 | Sapien vs Evolut: A Head-to-Head Study Seems Mandatory

Two French registries have carried out a propensity matched comparison which suggest differences between balloon-expandable valves (BEV) and self-expandable valves (SEV) in hard end points such as mortality.&nbsp; The only FDA approved commercially available transcatheter heart valves in the US are the BE Sapien 3 (Edwards Lifesciences) and the SE CoreValve Evolut PRO (Medtronic). Both<a href="https://solaci.org/en/2019/11/27/aha-2019-sapien-vs-evolut-a-head-to-head-study-seems-mandatory/" title="Read more" >...</a>

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