La estrategia invasiva precoz beneficia a los pacientes de alto riesgo

Early Invasive Strategy Benefits High-Risk Patients

Early angiography is not associated with a reduction in mortality compared with a more delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, a new meta-analysis published by The Lancet supports the idea that certain high-risk patients would benefit from it. Patients with elevated cardiac biomarkers, a high GRACE score, diabetes, or advanced<a href="https://solaci.org/en/2017/09/01/early-invasive-strategy-benefits-high-risk-patients/" title="Read more" >...</a>

Sorpresivo hallazgo en diabetes y permeabilidad de los bypass

Striking Finding on Diabetes and Bypass Graft Patency

The higher rate of restenosis in the diabetic population is historic and has been reproduced in all studies and with all kinds of stents, but it was only after the FREEDOM trial when we found out about the higher infarction rate with PCI compared to surgery. This is why 50% of patients undergoing CABG are diabetic. Apart from the above<a href="https://solaci.org/en/2017/09/01/striking-finding-on-diabetes-and-bypass-graft-patency/" title="Read more" >...</a>

Sangrado y mortalidad en el reemplazo valvular aórtico por catéter

Bleeding and Mortality in Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is much less invasive than surgical replacement. This is associated with a substantial reduction in bleeding events (up to 60% less). However, clinically relevant bleeding is still present in one every four patients who undergo TAVR, which is associated with morbidity and mortality.   Cases of bleeding are not uniform: they may<a href="https://solaci.org/en/2017/08/22/bleeding-and-mortality-in-transcatheter-aortic-valve-replacement/" title="Read more" >...</a>

¿Cómo objetivar la fragilidad en pacientes con estenosis aórtica?

How to standardize frailty in aortic stenosis patients

Frailty is the patient’s diminished capacity to recover after pathological or iatrogenic processes. It has a fundamental role when considering valve replacement, be it surgical (SAVR) or transcatheter (TAVR).   This was clearly observed in the PARTNER I and Core-Valve Pivotal trials, which showed that despite a 95% technical success, 2 in 5 patients showed poor quality<a href="https://solaci.org/en/2017/08/16/how-to-standardize-frailty-in-aortic-stenosis-patients/" title="Read more" >...</a>

El deterioro de las válvulas por catéter es raro y no debería impedir el avance a poblaciones más jóvenes

Valve Deterioration after TAVI Is Rare and Should Not Prevent Advancement to Younger Populations

Durability ─or better yet, lack of deterioration─ is still a matter of debate when considering transcatheter aortic valve intervention (TAVI), especially now that it is being explored as a real alternative for younger patients. A recently published meta-analysis offers more evidence and suggests TAVI deterioration is mostly rare within the first 5 years.   According to<a href="https://solaci.org/en/2017/08/14/valve-deterioration-after-tavi-is-rare-and-should-not-prevent-advancement-to-younger-populations/" title="Read more" >...</a>

Lotus vs Sapien 3, mecanismos diferentes con resultados similares

Lotus vs Sapien 3, different mechanisms with similar results

The new generation devices for transfemoral transcatheter aortic valve replacement have been optimized to improve valve position and reduce residual aortic regurgitation.   This study compared 30 day, 12 month and 24 month outcomes of the repositionable, Lotus valve, with controlled mechanical expansion, and the balloon-expandable valve Edwards Sapien 3.   Primary end point was all cause mortality<a href="https://solaci.org/en/2017/07/26/lotus-vs-sapien-3-different-mechanisms-with-similar-results/" title="Read more" >...</a>

Protection Systems Reduce Stroke and Mortality in Carotid Artery Stenting

So far, the main controlled randomized studies have almost exclusively been aimed at comparing the efficacy and safety of carotid artery stenting vs. endarterectomy. Almost all of them have left at operator discretion the choice of the devices to be used during the procedure, which is why there is few direct information to help us<a href="https://solaci.org/en/2017/07/21/protection-systems-reduce-stroke-and-mortality-in-carotid-artery-stenting/" title="Read more" >...</a>

CRM vs DES: ¿Cuál se asocia mejor calidad de vida a largo plazo?

MRS vs. DES: Which one is associated with better long-term quality of life?

The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization. Up to this work, patient sensations (which can be<a href="https://solaci.org/en/2017/07/21/mrs-vs-des-which-one-is-associated-with-better-long-term-quality-of-life/" title="Read more" >...</a>

NOTION: TAVI with Low Risk at 4 Year Follow Up

Post-dilation in TAVI associated to more stroke and more paravalvular regurgitation

Courtesy of Dr. Carlos Fava. Moderate/severe paravalvular regurgitation (PVR) after TAVR is present in 10%-14% of all cases, according to different series. The treatment of choice is post-dilation, generally effective in most cases. However, this strategy carries a risk of stroke. The true impact of this conduct is still unclear.   This review analyzed 6 studies that included 5007 patients; 889 of<a href="https://solaci.org/en/2017/07/10/post-dilation-in-tavi-associated-to-more-stroke-and-more-paravalvular-regurgitation/" title="Read more" >...</a>

El reemplazo transcatéter en válvulas bicúspides suma evidencia pero continúan los desafíos

Transcatheter valve replacement in the bicuspid valve is increasingly performed, but challenges remain

As experience increases, transcatheter aortic valve replacement (TAVR) has expanded to different populations and anatomies. This study sought to compare technical and clinical outcomes in patients with bicuspid versus tricuspid aortic stenosis from the Bicuspid AS TAVR Multicenter Registry.   Outcomes of 561 patients with bicuspid valves and 4546 patients with tricuspid valves were compared. Propensity score matching was used<a href="https://solaci.org/en/2017/07/05/transcatheter-valve-replacement-in-the-bicuspid-valve-is-increasingly-performed-but-challenges-remain/" title="Read more" >...</a>