Life-threatening complications that require surgery during TAVR are infrequent. The proportion was originally thought to be between 1% and 2%. However, we now know that it is lower, even though we do not know how frequent it is or what are its most common causes. Its evolution, both in the short and in the long<a href="https://solaci.org/en/2018/02/28/is-emergency-cardiac-surgery-necessary-in-tavr/" title="Read more" >...</a>
While the endovascular repair of aortic aneurysms has steadily become the number one option for aneurysms in which necks are adequate and which meet the specifications of device manufacturers. New technologies have arisen. These advancements allowed the expansion of this indication to more complex anatomies, such as those involving a short neck, no neck, or<a href="https://solaci.org/en/2018/02/23/cost-effectiveness-of-endovascular-and-surgical-repair-of-complex-aneurysms/" title="Read more" >...</a>
The association between aortic stenosis and coronary disease is common, since both conditions share pathogenesis, risk factors, and symptoms. Transcatheter aortic valve replacement (TAVR) is currently indicated for high-risk and inoperable patients. It also appears as a valid alternative for the treatment of intermediate-risk patients, and it could soon be indicated for low-risk patients. Coronary<a href="https://solaci.org/en/2018/02/20/coronary-disease-works-as-a-30-day-predictor-in-tavr/" title="Read more" >...</a>
Mitral paravalvular leaks are relatively common after surgical mitral replacement, with an incidence of 7%-17%. Most of these are subclinical leaks, a mere echocardiogram finding, but about 3% of patients can develop heart failure, hemolysis, or a combination of both, thus requiring a new intervention. For symptomatic patients, new surgery has been the traditional treatment<a href="https://solaci.org/en/2018/02/19/surgical-or-percutaneous-management-of-mitral-leak/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. Even though the presence of paravalvular regurgitation (PVR) has been reduced, thank to greater experience and new devices, it is still frequent and has an impact in survival (especially moderate and severe PVR). Recent research has shown that mild PVR also has a negative impact. However, these data were provided<a href="https://solaci.org/en/2018/02/15/mild-leaks-tavrs-silent-enemies/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. Currently, some small observational studies and a meta-analysis suggest that women experience more short-term complications after TAVR (due to higher rates of bleeding, vascular complications, and stroke), as well as less 1-year mortality. However, results are still conflicting. This work analyzed 17 studies including 8 different registries, with a total 23,303 women and 23,885 men.<a href="https://solaci.org/en/2018/02/14/who-lives-longer-after-tavr-men-or-women/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. In most randomized or observational studies, women comprise more than 50% of patients undergoing TAVR, and they have showed better evolution, compared against surgery. The main differences between men and women with severe aortic stenosis are that women have smaller annular dimension, shorter distance to coronary ostia, smaller peripheral arteries, and<a href="https://solaci.org/en/2018/01/24/win-tavi-the-largest-female-tavr-registry-so-far/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. Peripheral vascular diseases (PVD) present the same risk factors as aortic stenosis. In consequence, these disorders usually coexist. The frequency and impact of their various stages on patients undergoing TAVR is yet to be thoroughly assessed. Read also: “Peripheral Vascular Disease Is Associated to More Events in TAVR”. This study analyzed<a href="https://solaci.org/en/2018/01/15/critical-lower-limb-ischemia-should-be-taken-into-account-in-tavr/" title="Read more" >...</a>
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are commonly used to assess physiological severity of angiographically intermediate stenosis. Both indexes quantify a pressure ratio as subrogate to measuring flow, which is much harder to do. Discordance between FFR and iFR occurs in up to 20% of cases, which should not be a matter<a href="https://solaci.org/en/2018/01/14/physiologically-assessing-intermediate-stenosis-could-ffr-be-replaced/" title="Read more" >...</a>
The main advantage of transcatheter aortic valve replacement (TAVR) has always been its less invasive nature, compared against surgery. Many of the advances in this technique revolve around making it even less invasive, increasing the gap between the two. The kind of anesthesia has been one of these many advances. There are several reports (in general from<a href="https://solaci.org/en/2018/01/05/the-perks-of-conscious-sedation-in-tavr/" title="Read more" >...</a>