Patients presenting aortic stenosis with cardiogenic shock are at extreme risk, with 70% mortality until the aortic obstruction is resolved, and taking into account they make poor transplant candidates. Safety and efficacy of TAVR in patients with cardiogenic shock remains unclear. The aim of this study was to assess events in patients undergoing TAVR with...
With the treatment of aortic valve disease in younger patients, a significant number of them will need redo TAVR at some point in their life. However, to date there are few data on redo TAVR. The aims of this study was to look at real life experience on redo TAVR with balloon-expandable SAPIEN valves and...
Coronary artery disease (CAD) coexists with aortic stenosis in about half the patients who suffer the latter. These patients receiving antiplatelet therapy are at a higher risk of periprocedural bleeding—one of the most frequent complications in patients who undergo transcatheter aortic valve replacement (TAVR). One way of limiting the risk for bleeding is choosing the...
One of the challenges that transcatheter aortic valve replacement (TAVR) continues to face is percutaneous access closure with percutaneous closure systems (PCS). However, several systems have been developed, either by plug—such as the MANTA system—or by suture (SU)—such as the ProStar and ProGlide systems. Both of these have been tested in different analyses, but to...
Prosthesis-patient mismatch (PPM) was initially proposed by Rahimtoola and reintroduced by Pirabot. PPM is the indexed effective orifice area in relation to body surface area, cutoff value being 0.85 cm2/m2, and <0.70 cm2/m2for obese patients. PPM is considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2 Research studies on surgical prosthesis have...
Amyloidosis is a systemic disease that affects different organs and impairs their function. Recent studies with magnetic resonance imaging (MRI) have shown that between 13% and 16% of patients who undergo transcatheter aortic valve replacement (TAVR) have amyloidosis. A review of four studies showed that mortality at 20 months was twice as high when amyloidosis...
At present, surgical aortic valve replacement (SAVR) uses bioprostheses. However, when these fail, we are presented with a great challenge, seeing as repeat SAVR involves a higher risk. In this context, valve-in-valve (V-in-V TAVR) has surged as a very attractive alternative. Bioprosthesis fracture (BPF) is a new interesting strategy that has shown lower gradient and...
At present, the transfemoral access (TFA) is the preferred approach when it comes to transcatheter aortic valve replacement (TAVR). However, 5 to10% of PAD patients present tortuous iliac anatomy and calcification, aortic aneurysms or prior peripheral intervention, which makes it impossible. There are several alternatives to approach these patients: 1) TFA associated to peripheral PCI...
At present, transcatheter aortic valve replacement (TAVR) has become the gold standard in the US, regardless surgical risk. The current ACC and AHA guidelines recommend that a Heart Team make the decision for 65 to 80-year-old patients with aortic stenosis. In low risk patients, fast recovery and short term benefits of TAVR should be weighed...
The safety and efficacy of transcatheter aortic valve replacement (TAVR) is already established. However, it still poses a challenge for conduction disturbances, such as the need for pacemaker or new onset left bundle branch block (LBBB). The current rate for the latter ranges from approximately 11% to 19%. In most cases, 50% of LBBB reverses...