Transcatheter aortic valve replacement (TAVR) has become the standard of care for patients with severe aortic stenosis and high surgical risk, and it should be considered as an option for intermediate-risk patients. In recent years, the number of low-risk patients treated with TAVR has increased. This study analyzes low-risk patients from the German Aortic Valve…
Would TAVR Have a Similar Benefit in Patients with Low Flow, Low Gradient, and Preserved Ejection Fraction?
Courtesy of Dr. Carlos Fava. Patients with low-flow low-gradient severe aortic stenosis are at higher risk, but there is a low-flow low-gradient group with preserved ejection fraction. These patients present systolic and diastolic ventricular dysfunction and their progress is different than that of the high-flow high-gradient normal ventricular function group. This study analyzed 1462 patients. Among them,…
TAVR Learning Curve and Volume-Outcomes Relationship Plateau
Every operator keeps track of their cases. Have they reached their potential or are they still learning and improving their technique? After 1000 procedures, can we expect them to have better results than someone that has only done 500? Prior studies have reached conflictive results and consequently the relationship between learning curve and volume-outcomes remains…
Un Underestimated Symptom of Aortic Stenosis
For the first time, this long term observational study on a large cohort of contemporary patients with aortic stenosis (AS), has shown syncope is an underestimated threat, associated with worse prognosis after surgical aortic valve replacement (SAVR). It is interesting to note that other symptoms or early signs of AS that will normally indicate SAVR…
Aortic Stenosis and Dialysis: Is TAVR the Strategy of Choice?
Courtesy of Dr. Carlos Fava. TAVR has been shown beneficial in high and moderate risk patients, but there is a group of patients that require dialysis on account of kidney deterioration. This comorbidity is due to bad cardiovascular evolution associated to diabetes, bleeding and thromboembolic events. For some time, we have been using an…
iFR Assessment of Intermediate Aortic Stenosis Lesions Consolidates
Once a big void that prevented us from effectively assessing functional compromise, intermediate aortic stenosis has made us treat many lesions “just in case”, to save us what would be a complicated procedure, had a valve been placed. Auspiciously, some light has been shed by several, most welcome, studies simultaneously published in J Am Coll…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
More Favorable Evidence for TAVR in Severe Aortic Regurgitation
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) was developed for aortic stenosis, but there is a significant number of patients with severe aortic regurgitation who still undergo this procedure as an off-label indication. Current evidence for this procedure in relation with this disease is growing, mainly due to good results obtained by different…
Post-Dilation in Valve-in-Valve Implantation Offers Hemodynamic Improvement
Courtesy of Dr. Carlos Fava. A significant number of patients present severe aortic stenosis and undergo surgery with 19-to-21-mm bioprostheses. These patients frequently evolve with high gradients and receive Valve-in-Valve (ViV) implantation. In about a third of patients with high post-procedural gradient (≥20 mmHg), this has been associated with poor outcomes. This study analyzed 30 patients who underwent…
Bicuspid Valves Do Not Increase Mortality in TAVR
The frequency of bicuspid aortic valves (BcAV) are around 1%, but in 60+ patients it is associated to severe aortic stenosis. Even though surgery is the standard treatment, TAVR is the “off label” indication in high risk patients. BcAV presents differences with tricuspids given that it is more elliptic, has asymmetric calcification and more…