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...
The number of centers that are starting endovascular stroke therapy (EST) to treat acute stroke is growing fast, with a significant increase of cases in low volume centers. Interventional neurologists are not able to cover the high demand and interventional cardiologists are always ready to learn something new. Is this right? Should interventional cardiologists treat...
Courtesy of Dr. Carlos Fava. Asymptomatic severe aortic stenosis with preserved ventricular function is challenging. At present, it remains unclear whether we should operate or not and, according to some recent reports, neither do we know what patients will benefit from surgery. The study looked at 1678 patients with asymptomatic or minimally asymptomatic severe aortic...
Men gender, kidney failure and atrial fibrillation are the factors that most affect 3-year mortality after transcatheter aortic valve replacement. On the other hand, surprisingly enough, anticoagulation (mostly indicated for atrial fibrillation) reduces mortality risk – especially the risk of valve deterioration – after TAVR. Should anticoagulation be included in post TAVR protocols? This question...
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...
The degeneration of transcatheter biological valves clearly depends on time and starts with thrombus generation and subsequent histological changes resulting in valve failure (due to regurgitation, stenosis, or both). Thrombus formation is the first change, observed early in computerized tomography (CT) scans after implantation. Most times it is completely asymptomatic, which leaves many of us...
Courtesy of Dr. Carlos Fava. The development of new valves for TAVR and the increased experienced of operators have significantly decreased paravalvular leak. However, new bundle Branch block (BBB) and the need for permanent pacemaker (PPM) are still relatively high, and their impact and evolution remain controversial. The study looked at 816 patients, 437...
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,...
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...
Is the Obesity Epidemic Putting Patients’ and Physicians’ Health at Risk? In addition to the obvious negative effect on patients, obesity can also affect Interventional Cardiologists’ health, seeing as it involves increased exposure to radiation. Operators are clearly and increasingly exposed to radiation as patient body mass index (BMI) increases. Radiation exposure might be...