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...
Dr. Kini presented the results of the YELLOW III Study where she analyzed the effect of evolocumab on coronary plaque in patients with stable coronary artery disease. The study included 137 patients who underwent coronary angioplasty to the culprit vessel and endovascular imaging (OCT, NIRS/IVUS) to non-obstructive lesions (30%-50%). If their plaque was lipid-rich (defined...
Pulmonary vessels are densely innervated by sympathetic, parasympathetic, and sensitive fibers. According to the World Health Organization (WHO) pulmonary arterial hypertension (PAH) grade 1 consists of obliterating pulmonary vascular remodeling accompanied by a diminished generation of vessel dilators. Its pharmacological treatment has certain limitations and sympathetic pulmonary vascular denervation might be a valid treatment alternative,...
Pulmonary hypertension is associated with higher mortality after both aortic valve replacement and transcatheter aortic valve replacement (TAVR). This is a dynamic phenomenon, and what happens after TAVR —during the periprocedure— and its impact are yet to be evaluated. Researchers conducted a subanalysis of the Japanese OCEAN TAVI Registry, which included 1872 patients who were divided...
Mitral regurgitation (MR) is the most frequent type of valve heart disease, and the COAPT has shown that edge-to-edge with guideline directed medical treatment (GDMT) at maximal tolerated dose (MTD) is superior to medical treatment alone. However, we did not have a score to predict patient evolution when treated with this strategy. Researchers analyzed the...
Primary Pulmonary Hypertension is behind multiple hospitalizations and pulmonary transplants. Even though its treatment has been advanced, many patients will not respond well. The PADN-CFDA randomized 128 patients, 63 received pulmonary denervation (PADN) and 65 went to the control group. Primary end point was 6-minute walk distance test at 6 months. The populations were similar,...
Coronary physiology, FFR and iFR, has been shown safe to defer lesions and effective to save stents by different randomized studies and registries. However, patients with chronic kidney disease have not been thoroughly analyzed yet, which brings us to the question about what to do in the face of their negative evolution, when atherosclerosis develops...
Intervention of chronic total occlusions (CTO) through angioplasty (PCI) can cause complications, even in highly experienced centers. Plenty has been written on the probability of success for the treatment of CTOs using scores such as CL-SCORE, J-CTO, ORA, E-CTO, CASTLE-CTO, etc. (some of which are usually used when preparing these cases). However, besides estimating success...
Second generation drug-eluting stents have lower frequency of thrombotic complications and in-stent restenosis. While clinical results have significantly improved, having a 2-3% annual rate of these complications within the first year after angioplasty is still worrisome. This resulted in the development of stents with struts <70 µm (ultrathin), with bioresorbable polymer and abluminal cover. Stents...
Currently, the number of nonagenarian patients undergoing angioplasty (whether elective, urgent or emergency) has increased. This population is linked to more comorbidities and has barely been included in most randomized studies or registries. As such, we do not have robust evidence on this group. Researchers conducted an analysis of the J-PCI OUTCOME Registry, in which...