Transcatheter aortic valve intervention (TAVI) has been shown beneficial over the years. However, a significant subgroup of patients with small aortic annulus, which make approximately one third of cases and have a higher incidence in women, face additional challenge, such as higher incidence of mismatch, reduced exercise capacity and shorter durability. Self-expanding and balloon expandable...
Transcatheter Myotomy for the Treatment of the Dynamic Obstruction of the Left Ventricular Outflow Tract
Septal reduction therapies are used to mitigate the symptoms caused by dynamic left ventricular outflow tract (LVOT) obstruction and the associated mitral regurgitation (MR) that can surge in hypertrophic cardiomyopathy (HCM). Alternative therapies to treat LVOT obstruction include surgical procedures, i.e. surgical myotomy or myomectomy, or alcohol and radiofrequency septal ablation (intracardiac, transthoracic and endocardial,...
NOTION Trial: 10 Year Outcomes, TAVR vs. SAVR in Low Risk Patients
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis (AS). Randomized studies have shown the benefits of TAVR for treating inoperable patients, as well as high and intermediate risk patients. The NOTION (Nordic Aortic Valve Intervention Trial) randomized patients with low risk severe AS to TAVR or SAVR (surgical...
TENDER Study, Evolution at One Year
The use of transcatheter mitral valve intervention for the treatment of mitral valve regurgitation (MR) continues to evolve; at present guidelines only recommend it for inoperable or high surgical risk patients. So far, many devices have been assessed, some of which have shown promising results, but only for poor surgical candidates. Researchers looked into the...
Tricuspid Valve Transcatheter Edge-to-Edge Repair in the “Real World”
Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is currently under development, with an increasing number of conducted procedures. While the TRILUMINATE Study did not reveal benefit regarding major events, it did show improvements in quality of life. In the real world, we encounter numerous patients who do not meet the study criteria but still experience symptoms...
Edge-to-Edge Repair in Cardiogenic Shock
The edge-to-edge approach with MitraClip has been established as a valid strategy for patients who experience severe symptomatic mitral regurgitation (MI) with high risk for surgery, currently with a IIa indication. MI complicated by cardiogenic shock, which results in a high risk for conventional valve surgery, is a particularly complex scenario. In such a case,...
TAVR in Low Risk Patients: 10 Year Evolution
The Treatment of severe aortic stenosis has experienced a significant revolution with TAVR, especially in high and intermediate risk patients, and it is now extending to low risk patients. In the US, nearly half of patients under 64 are being treated with TAVR. One of the fundamental questions that still remains unanswered revolves around device...
Does Post-Dilation in TAVR Affect its Long-Term Outcomes?
Transcatheter aortic valve replacement (TAVR) has widely demonstrated its significant benefits, both in high-risk and inoperable patients, as well as in those with intermediate and low risk. While paravalvular regurgitation has been a challenge, its management has improved with operator experience and a deeper understanding of CT angiographies. However, in cases of regurgitation, elevated gradient,...
Promising Results of Transcatheter Mitral Valve Replacement in Bioprosthesis Failure
Failure of a mitral bioprosthesis always poses a challenge regarding decision-making, especially when dealing with elderly patients with multiple risk factors. The scenario is worsened by the high risk associated with a new sternotomy and the significant impact of undergoing new surgery. Transcatheter mitral valve-in-valve (TMViV) replacement is emerging as a valid strategy in the...
Transcatheter Mitral Valve Replacement: DOAC or VKA?
Severe mitral disease is common and currently constitutes a frequent cause of hospitalization and death. While surgery is the treatment of choice, transcatheter mitral valve replacement (TMVR) emerges as a valid alternative in cases of bioprosthesis failure, ring malfunction, or severe mitral annular calcification (MAC). Furthermore, the latest medical guidelines support the recommendation of TMVR...