For this Canada-based study, the increased number of patients who required a transcatheter aortic valve replacement (TAVR) may have come hand in hand with an equal increase in healthcare financing, so as to cover procedural costs. In spite of that, the wait-time between the formal request for authorization and the actual procedure was 3 months, and<a href="https://solaci.org/en/2018/04/21/morbidity-and-mortality-during-authorization-wait-times-for-tavr/" title="Read more" >...</a>
Do the Best Coronary Revascularization Prior TAVR
The presence of coronary artery disease (CAD) in patients with aortic stenosis is high, reaching 50% to70% of cases. This poses a great challenge as to what strategy to use and the things we can do. Even though it has been shown complete revascularization is beneficial, it is often difficult to achieve. Instead, reasonable incomplete<a href="https://solaci.org/en/2018/04/18/do-the-best-coronary-revascularization-prior-tavr/" title="Read more" >...</a>
TAVR in Patients with Classical Low Flow, Low Gradient
Classical symptomatic low-flow, low-gradient (LFLG) severe aortic stenosis is associated with low survival rates at 3 years (<50%). However, in the medium term and with surgery, those rates improve (although mortality rates are 6%-30%, depending on the series). In patients without contractile reserve, surgical mortality is higher. Patient evolution in TAVR is still mostly unclear. <a href="https://solaci.org/en/2018/04/12/tavr-in-patients-with-classical-low-flow-low-gradient/" title="Read more" >...</a>
Diastolic Dysfunction Should Be Considered in TAVR
Aortic stenosis increases afterload creating hypertrophy as a compensation mechanism to maintain minute volume. This leads to left ventricular diastolic dysfunction (LVDD). More than half of patients presenting aortic stenosis have LVDD and myocardial fibrosis, which is a mortality predictor in surgery. At present, there is contradicting evidence in TAVR. The study looked<a href="https://solaci.org/en/2018/04/12/diastolic-dysfunction-should-be-considered-in-tavr/" title="Read more" >...</a>
Delayed Coronary Obstruction After TAVR: A Complication We Had Not Considered
Delayed coronary obstruction (after TAVR, outside the cath lab) is a rare complication with high mortality rates, not unlike acute obstruction. Cardiologists should be expectant and, upon the slightest suspicion of this complication, patients should be brought back to the cath lab for a coronary angiography. Occlusion immediately after implant release has been well-studied and<a href="https://solaci.org/en/2018/04/11/delayed-coronary-obstruction-after-tavr-a-complication-we-had-not-considered/" title="Read more" >...</a>
NOTION: 5-Year Outcomes of TAVR vs. Surgery in Low-Risk Patients are Promising
At 5 years, there were no differences in all-cause death, stroke, acute myocardial infarction, or all of these combined between low-risk, elderly patients who underwent transcatheter aortic valve replacement (TAVR) or conventional surgery. Taking into account reports from previous years, these results are not at all surprising. NOTION enrolled an all-comers population that was 70 years old<a href="https://solaci.org/en/2018/04/04/notion-5-year-outcomes-of-tavr-vs-surgery-in-low-risk-patients-are-promising/" title="Read more" >...</a>
Permanent Pacemaker: still TAVR’s Aquila’s Heel
TAVR has shown benefits in high risk patients (prohibitive) and in intermediate risk patients, but the need for permanent pacemaker implantation (PPI) continues to be a soft spot (especially in younger patients) given time of use, eventual replacement and associated complications. Even though there is little information on PPI, pacemakers are not associated with higher mortality, but they<a href="https://solaci.org/en/2018/04/04/permanent-pacemaker-still-tavrs-aquilas-heel/" title="Read more" >...</a>
Next-Day Discharge after TAVR: Is It Viable?
Next-day discharge after transfemoral transcatheter aortic valve replacement (TAVR) might be viable, with no major complications at 30 days or one year, compared against patients with longer hospital stay. We only have to consider a few factors that will help us choose the most adequate patients for this modality without compromising safety. One of the main advantages<a href="https://solaci.org/en/2018/03/19/next-day-discharge-after-tavr-is-it-viable/" title="Read more" >...</a>
Red Light for TAVR in Low Surgical Risk Patients
A new study raises an alarm against expanding transcatheter aortic valve replacement (TAVR) procedures to low surgical risk patients, since 2 year mortality seems higher in these patients with TAVR, compared to conventional surgery. This study will soon be published in Catheter Cardiovasc Interv. Expanding TAVR to low risk patients might involve risks we have not<a href="https://solaci.org/en/2018/03/14/red-light-for-tavr-in-low-surgical-risk-patients/" title="Read more" >...</a>
These were the 5 most read scientific articles of February
1) The CULPRIT-SHOCK Study Is Finally Published in NEJM and It Is Bound to Change Guidelines During SOLACI’s coverage of the TCT 2017 Congress in Denver, Colorado, we already mentioned some of the outcomes of this study that has arrived to revolutionize clinical practice, given the differences between its results and those of the classic SHOCK trial, which has marked<a href="https://solaci.org/en/2018/03/01/these-were-the-5-most-read-scientific-articles-of-february/" title="Read more" >...</a>