Tag Archives: aortic stenosis

More Keys to Define Moderate Aortic Stenosis

More Keys to Define Moderate Aortic Stenosis

Amidst the current efforts to prove early intervention might have benefits in moderate aortic stenosis (AS), this trial comes along directing us back to basics.  In patients with symptomatic aortic stenosis, peaking mortality will clearly justify intervention. But what is the case when there are no symptoms? According to this recent analysis published in JAMA,

Resonancia vs FFR en lesiones no culpables del infarto

New Markers of Aortic Stenosis Define Asymptomatic Patients

Asymptomatic aortic stenosis has been keeping us in tense stillness. However, there are new markers capable of identifying patients that might benefit from earlier intervention. In this regard, cardiovascular magnetic resonance (CMR) has been gaining its well-deserved place in cardiology and now more specifically in aortic stenosis.  This study sought to validate CMR markers of

Evolut Low Risk

EuroPCR 2021 | Evolut Low Risk: Two-Year Results of The Self-Expanding Valve in Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) with the Evolut self-expanding valve was non-inferior to surgery in patients with low surgical risk. After two years, the primary endpoint of death or disabling stroke was similar between both strategies. This presentation at EuroPCR 2021 reinforces the results presented during the American College of Cardiology (ACC) 2019 Congress and

Tasa de stroke post cirugía vs angioplastia coronaria en un análisis de más de 10.000 pacientes

Surgeons’ Claim on Low-Risk Patients with Aortic Stenosis

Recent randomized trials including low-risk patients showed positive results for transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement. However, surgeons argue that these cases fail to consider patients from daily clinical practice, but rather include a population that has been carefully selected for randomized trials. Patients with non-tricuspid aortic stenosis, with severe

Cirugía para mejorar la sobrevida en insuficiencia tricuspidea aislada

Cusp Overlap for Higher CoreValve Implantation

Implant depth greater than the length of the membranous septum is an independent predictor of permanent pacemaker implantation. Valve implantation 3 to 5 mm below the aortic annulus in a projection coaxial to the device is recommended. The problem is this is rarely in the annular plane of the valve. Ideal annular plane projection is

tavi estenosis aortica severa

Diastolic Dysfunction and TAVR: Prognosis before and after Procedure

The PARTNER 2 SAPIEN 3 showed baseline diastolic dysfunction is a predictor of clinical events after 2 years of TAVR. As expected, improved diastolic function after procedure immediately changes prognosis.  Though these outcomes did meet our expectations, very few studies have shown hard evidence linking diastolic dysfunction and aortic stenosis.  All patients included in the

Nuevas guías de valvulopatías con actualizaciones clave en TAVI e insuficiencia mitral

New Valvular Heart Disease Guidelines with Key TAVI and Mitral Regurgitation Updates

Valvular heart disease management guidelines were updated last week by the AHA and the ACC.  The last complete version had been published in 2014; therefore many of its recommendations have become obsolete before the latest evidence.  The studies that made the FDA approve TAVI for low-risk patients are probably the most important incorporations. They also

TAVI: Balón expandible o autoexpandible ¿Cuál es la respuesta?

Considerations for Optimal Device Selection in TAVR

Many studies have tried to answer the question about whether there is a superior device in transcatheter aortic valve replacement (TAVR). Today, there is no evidence to support such claim, and most patients will likely find operator experience more beneficial than any device per se.   However, there are certain patients with specific characteristics that might

La válvula CoreValve Evolut R arroja resultados positivos en una población importante de pacientes La Evolut R, al igual que su predecesora CoreValve, es una válvula autoexpandible, supra-anular, de pericardio porcino en un stent de nitinol. Entre las mejoras de esta válvula se pueden enumerar su mejor perfil y la posibilidad de re-envainarla. Esto la hace completamente reposicionable e incluso recapturable. Faltaba ver si estas ventajas técnicas se traducirían en ventajas clínicas (lo cual es -en definitiva- lo que importa) en una población grande de pacientes del mundo real. El estudio FORWARD (CoreValve Evolut R FORWARD) es un registro prospectivo que incluyó 1038 pacientes de 53 centros y cuatro continentes. Los pacientes tuvieron una edad media de 81.8 ± 6.2 años y un STS de 5.5 ± 4.5%, lo cual constituye un riesgo intermedio y coincide con la tendencia actual de la práctica clínica. La capacidad de reposicionar la válvula debió ser utilizada en el 25.8% de los pacientes, característica que permitió el implante de una sola válvula en el lugar correcto en el 98.9% de los casos. A 30 días, la mortalidad fue del 1.9% y el stroke incapacitante del 1.8%. Solo el 1.9% de los pacientes presentó insuficiencia aórtica moderada a severa; la tasa de marcapaso definitivo fue del 17.5%. Ambos datos están por debajo de lo que mostró el estudio SURTAVI con la CoreValve en una población similar (3.4% y 25.9% respectivamente) y la mejora se puede atribuir a la posibilidad de reposicionar el dispositivo. Conclusión La nueva generación de la válvula autoexpandible es segura y efectiva en pacientes con estenosis aórtica severa no seleccionados del mundo real. Comentario editorial La mortalidad por cualquier causa del 1.9% está claramente por debajo del 5.5% esperado según el score de STS y en sintonía con la del 1.1% descripta en el registro que testeó la última generación de la válvula balón expandible SAPIEN 3 en una población similar. El 98% de los pacientes fueron tratados por acceso femoral, lo cual también es la tendencia mundial gracias a la significativa disminución del perfil de los dispositivos. Afortunadamente, la enorme mayoría de las mejoras técnicas que han incorporado los nuevos dispositivos (tanto este como la competencia) han logrado traducirse en mejoras clínicas para los pacientes, logrando reducir la insuficiencia paravalvular, la tasa de marcapaso y las complicaciones vasculares. Título original: Clinical Outcomes With a Repositionable Self-Expanding Transcatheter Aortic Valve Prosthesis. The International FORWARD Study. Referencia: Eberhard Grube et al. J Am Coll Cardiol 2017;70:845–53.

After 8-year Followup, Good News for the Self Expandable Valve

As the transcatheter aortic valve replacement (TAVR) gains ground in lower risk populations and with better survival rate, concern over its durability has grown.  This study brings us data and good news on the first-generation self-expandable valve after quite a long follow up. It included 990 inoperable or high-risk patients treated with CoreValve in 8

La revascularización incompleta se asocia a mortalidad en el TAVI

Post TAVR Regression of Ventricular Mass

This study looked at patients with moderate to severe left ventricular hypertrophy and aortic stenosis treated with transcatheter aortic valve replacement (TAVR). Patients with reduced hypertrophy had lower mortality and fewer hospitalizations at 5 years.  It included all moderate to severe risk patients with ventricular hypertrophy undergoing TAVR in the studies and registries PARTNER (I,

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