TAVR in Low-Flow Low-Gradient Aortic Stenosis and Severe Impairment of Systolic Function

Patients with low-flow, low-gradient severe symptomatic aortic stenosis associated with severe impairment of the left ventricular systolic function have shown acceptable outcomes after transcatheter aortic valve replacement (TAVR), according to the multicenter TOPAS-TAVI registry, which demonstrated a relatively low 30-day mortality rate.   Considering the very high risk presented by this population involved, a 30-day<a href="https://solaci.org/en/2017/01/06/tavr-in-low-flow-low-gradient-aortic-stenosis-and-severe-impairment-of-systolic-function/" title="Read more" >...</a>

Predictores de marcapasos definitivo con SAPIEN 3

Permanent Pacemaker Predictors with SAPIEN 3

The aim of this study was to identify permanent pacemaker (PPM) predictors after transcatheter aortic valve replacement (TAVR) with last generation balloon expandable valve Edwards SAPIEN 3.   The new conduction disturbances requiring PPM are one of the biggest concerns after TAVR, and their predictors have not yet been defined.   229 patients undergoing TAVR<a href="https://solaci.org/en/2017/01/03/permanent-pacemaker-predictors-with-sapien-3/" title="Read more" >...</a>

Paravalvular Leak in Surgical Prosthesis: How to Treat Them

Courtesy of Dr. Carlos Fava. The presence of paravalvular leaks (PVL) after aortic valve replacement ranges between 5% and 20%. Percutaneous repair has emerged as a feasible alternative, effective and safe, to prevent new surgery.   The study included 86 patients undergoing aortic valve replacement presenting PVL with cardiac failure CFIII or IV and/or anemia.<a href="https://solaci.org/en/2016/12/26/paravalvular-leak-in-surgical-prosthesis-how-to-treat-them/" title="Read more" >...</a>

Myocardial Revascularization Surgery: One or Two Internal-Thoracic-Artery Grafts?

The use of both internal thoracic (mammary) arteries for myocardial revascularization surgery might improve long-term outcomes, compared with the use of a single internal thoracic artery.   Patients scheduled for myocardial revascularization surgery (only multivessel procedures; combined valve procedures were excluded) were randomized to receive a single internal-thoracic-artery graft (internal thoracic artery for the anterior<a href="https://solaci.org/en/2016/12/21/myocardial-revascularization-surgery-one-or-two-internal-thoracic-artery-grafts/" title="Read more" >...</a>

Transcaval Access: Another Alternative to Femoral Access Counterindication

For TAVR eligible patients (transcatheter aortic valve replacement) with femoral access counterindication, a new access site, extra thoracic yet percutaneous, may offer an alternative. This consists of reaching the abdominal aorta through the vena cava.   With this technique the operator enters the abdominal aorta through the vena cava by electrifying a guidewire, advancing a<a href="https://solaci.org/en/2016/12/21/transcaval-access-another-alternative-to-femoral-access-counterindication/" title="Read more" >...</a>

Coronary Lesions After TAVR: Severity May Be Modified

Courtesy of Dr. Carlos Fava. Between 40% and 70% of patients undergoing transcatheter aortic valve replacement (TAVR) present coronary lesions. The fact that aortic stenosis affects how blockages act, and that, after stenosis correction, hemodynamic compromise for those same lesions may vary, has been consistently proven. Its management has not been determined yet.   The study<a href="https://solaci.org/en/2016/12/13/coronary-lesions-after-tavr-severity-may-be-modified/" title="Read more" >...</a>

TAVR in Pure Aortic Insufficiency: Yes or No?

Courtesy of Dr. Agustín Vecchia. Surgery is the treatment of choice for patients with symptomatic aortic insufficiency and/or ventricular dilatation or decreased ventricular function. The broad implementation of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, the emergence of new devices, and the experience acquired by operators have brought this treatment to off-label indications such<a href="https://solaci.org/en/2016/12/13/tavr-in-pure-aortic-insufficiency-yes-or-no/" title="Read more" >...</a>

TAVR: Transcarotid Access as a Valid Alternative

Courtesy of Dr. Carlos Fava. Transfemoral access is the first choice for transcatheter aortic valve replacement (TAVR). However, this approach is not feasible for a progressively larger number of patients, which establishes the need to search for alternative accesses.   Between 2009 and 2014, this study enrolled 174 patients who underwent TAVR and were unsuitable for transfemoral<a href="https://solaci.org/en/2016/12/06/tavr-transcarotid-access-as-a-valid-alternative/" title="Read more" >...</a>

TAVR: Pre-Existing Complete Right Bundle Branch Block Is Associated with Mortality

Courtesy of Dr. Carlos Fava. The fact that the presence of a complete right bundle branch block (RBBB) increases the risk of bradycardia, high-grade atrioventricular block, and need for a permanent pacemaker (PPM) after TAVR is well-known.   The impact of pre-existing complete right bundle branch block has not been well-studied.    This article analyses 749 patients enrolled in<a href="https://solaci.org/en/2016/12/05/tavr-pre-existing-complete-right-bundle-branch-block-is-associated-with-mortality/" title="Read more" >...</a>

accesos transapical transaortico femoral tavi

Transapical and Transaortic TAVR: Valid Alternatives to the Transfemoral

Courtesy of Dr. Carlos Fava.   The femoral approach has been the gold standard for the transcatheter aortic valve replacement procedure (TAVR); however, it is anatomically unsuitable for an important number of patients, and these require a different approach. At present, there is little evidence in support of the transapical or transaortic access sites as<a href="https://solaci.org/en/2016/12/02/transapical-and-transaortic-tavr-valid-alternatives-to-the-transfemoral/" title="Read more" >...</a>