tavi

Un seguimiento mínimo y apropiado reduce la mortalidad luego de una endoprótesis

Minimum Appropriate Follow-Up Reduces Mortality After Endoprosthesis Implantation

No study has been able to prove long-term benefit of regular imaging follow-up after abdominal aortic aneurysm repair by means of endoprosthesis implantation. This is important because the costs for these studies are high, which should be added to potential radiation and contrast morbidity. This work sought to characterize the association between post-endovascular abdominal aortic aneurysm...

bioresorbable-vascular-scaffold

Polymer-Free DES Also Show Efficacy in Anticoagulated Patients with High Risk for Bleeding

Patients who receive chronic anticoagulation therapy and then undergo angioplasty are frequently discharged on a triple anti-thrombotic scheme that usually includes aspirin, clopidogrel, and warfarin. The optimal duration of this indication remains unclear, particularly for patients at high bleeding risk. According to expert consensus, patients receiving chronic anticoagulation may receive from 1 to 12 months of dual...

COMPASS: un nuevo lugar para el rivaroxaban en cardiopatía isquémica crónica

COMPASS: A New Place for Rivaroxaban in Chronic Ischemic Heart Disease

Combining low doses of rivaroxaban and aspirin seems to be the best strategy for patients with stable chronic ischemic heart disease, according to this new study presented at the European Society of Cardiology Congress 2017, which was published simultaneously in the New England Journal of Medicine. Compared with low-dose aspirin alone, the combination of aspirin...

All you need to know about Nicaragua Sessions 2017

For the first time since the Regional Sessions first took place, SOLACI is landing in Managua (Nicaragua) to hold an event of paramount scientific value for Latin American interventional cardiology. The aim of this Sessions is, on one hand, to strengthen SOLACI’s ties with the region and, on the other hand, to promote the specialty’s...

Jornadas Colombia 2017

All you need to know about Colombia Sessions 2017

After 3 long years, SOLACI is coming back to Colombia to celebrate the 14th Regional Sessions in an unmissable event to continue to strengthen interventional cardiology in all Latin America. The meeting will take place in Bogota, on October 5 and 6, 2017. Are you planning on participating of the next Colombia Sessions 2017? Here...

La angioplastia “ad hoc” durante el TAVI no impacta en su seguridad ni en resultados a largo plazo

“Ad Hoc” PCI during TAVR: No Impact on Safety or Long Term Outcomes

According to a recent study published in Circulation Cardiovascular Interventions, screening for coronary artery disease (CAD) with an invasive coronary angiography  (as part of the protocol prior TAVR)  and performing PCI and TAVR in the same session, has no impact on periprocedural safety or on long term outcomes. Study outcomes offer new hope, especially as regards using TAVR...

SPYRAL HTN-OFF MED: Renal Denervation Reloaded?

This work presented at the ESC Congress 2017 held in Barcelona, simultaneously published in The Lancet, seems to give hope to all those that still believe in renal denervation. Interim outcomes suggest that a more intensive denervation of renal arteries, carried out at the SYMPLICITY HTN-3 trial, could reduce blood pressure in patients with untreated mild to moderate hypertension....

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.

Positive Outcomes of CoreValve Evolut in Large Population

The Evolut R, as well as its predecessor the CoreValve, is a self-expandable valve, supra-annular, made of porcine pericardium in a nitinol frame. Amongst its improvements, it has a better profile and the option to resheath. This makes it fully repositionable and even recapturable.   We only needed to confirm these technical advantages would translate into clinical...

Predicción de mortalidad en TAVI - Marcapaso

A Simple Electrocardiography to Predict Mortality in TAVR

Conduction abnormalities, such as new left bundle branch block, atrioventricular block, and need for a pacemaker, are still among the most frequent complications in transcatheter aortic valve replacement (TAVR). New valve generations have (mostly) not managed to reduce significantly electrical abnormalities; furthermore, some modifications such as external skirts, which are extremely effective for the reduction...

Diálisis post TAVI, una complicación grave que se hace menos frecuente

Post TAVR Dialysis: a Severe Complication Less and Less Frequent

The prevalence of pre-procedural kidney failure in patients undergoing transcatheter aortic valve replacement (TAVR) can be as high as 50 – 60% (stage 3 kidney failure or worse); it has been strongly associated with acute kidney deterioration and, ultimately, an increase of post TAVR mortality. A recent meta-analyzis of several small studies carried out in a single...

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