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…
Evolution of Bicuspid Valves at 12 Months
Severe aortic stenosis due to a bicuspid aortic valve (BAV) is uncommon, especially in individuals under 65 years of age. While there are usually no significant differences according to the type of valve when it comes to surgery, with transcatheter aortic valve replacement (TAVR) some may arise. TAVR has seen significant advancements in the treatment…
Avatar Trial: Is It Time to Use Surgical Aortic Valve Replacement in Asymptomatic Patients?
It is still unclear whether surgical aortic valve replacement (SAVR) is beneficial in asymptomatic patients with severe aortic stenosis (AS) and conserved left ventricular function (C1 indication according to AHA guidelines). The European American guidelines only recommend intervention in asymptomatic patient when there is ventricular compromise (ejection fraction <50%, class I indication) or with a…
AHA 2021 | AVATAR: Early Intervention in Asymptomatic Aortic Stenosis
Early surgical aortic valve replacement (SAVR) in patients with severe asymptomatic aortic stenosis can be beneficial in selected patients vs. waiting for symptoms. Severe AS in patients with no symptoms and conserved ventricular function raises few questions, clinically speaking. However, there is little evidence in favor of early intervention vs. close observation. The best data…
Self-Expanding Valve in Extreme Surgical Risk After 5 Years
Patients with aortic stenosis and extreme surgical risk have extremely high mortality due to known comorbidities. The short-term benefit of transcatheter aortic valve replacement (TAVR) with self-expanding valve is clear, and it warrants the procedure in this challenging population. While elderly patients with comorbidities who are at extreme surgical risk might be eligible for TAVR,…
SCOPE I: Acurate NEO vs Sapien 3, no non-inferiority at one year?
The randomized controlled study SCOPE 1 failed to show significant differences at one year between the self-expandable Acurate neo and the balloon expandable Sapien 3. The SCOPE 1 (Safety and Efficacy of the Symetis ACURATE neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis) compared the balloon expandable Sapien 3 (which has probably more data) against…
TAVR in Low-Risk Patients: Though still Superior, with Diminished Advantage after 2 Years.
At two-year followup, primary end point continued to be significantly lower with Sapien 3 vs. conventional surgery, but the initial difference in death and stroke in favor of TAVR started to shrink. In addition, there was higher risk of valve thrombosis in TAVR patients. The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter…
Death, Stroke, and Hospitalization while Waiting for TAVR
The consequences of deferring transcatheter aortic valve replacement (TAVR) procedures because of the COVID 19 pandemic are piling up. Untreated severe aortic stenosis patients who had been scheduled for TAVR are seeing increased risk of all events, even mortality. According to recent studies published in JAMA, deferring TAVR in patients with symptomatic aortic stenosis is…
TAVR as Anti-Inflammatory? An effect few imagined
We never saw it coming, such a pleiotropic effect: who would have though a mechanical device could have such a systemic anti-inflammatory effect? Transcatheter aortic valve replacement (TAVR) does in fact have it. The shear stress aortic stenosis produces activates multiple inflammatory responses mediated by monocytes. This study identified the most important mechanoreceptor, involved in…
Good Evolution of Bicuspid Valves with EVOLUTE or EVOLUTE PRO
Courtesy of Dr. Carlos Fava. TAVR has matured over time and has advanced onto low risk patients, but one of its greatest challenges continues to be bicuspid valve patients. These represent between 1% and 2% of the population and over 20% of young adults requiring surgical valve replacement (SAVR). The study looked at 27,086 patients…