When compared against surgical valve replacement (SAVR) transcatheter aortic valve replacement (TAVR) has shown benefits across different risk groups, not only in events as death and stroke, but also in quality of life (especially in the first months post procedure) and improved symptoms. However, a catch-up phenomenon was observed in low-risk patients between the first…
Infective Endocarditis in TAVR: What’s the Best Treatment?
Infective Endocarditis (IE) rate after TAVR ranges from 0.7% to 3.4%, depending on the different analyses, and is comparable to that after SAVR. Close to 50% of patients treated with surgery received a prosthetic valve; in TAVR, the figure is lower, possibly due to the characteristics of patients (even though it remains unclear). Researchers looked…
TCT 2021 | FAME 3: Surprises in a Long-Awaited Study
Angioplasty could not reach non-inferiority to surgery to treat patients with three-vessel lesions. In this head-to-head study of both revascularization strategies in patients with three-vessel coronary disease, fractional flow reserve (FFR)-guided angioplasty could not reach the performance of myocardial revascularization surgery in relation to a composite of adverse events. The FAME 3 study was presented during…
High Mortality Rates for Redo Surgery After TAVR
Courtesy of Dr. Carlos Fava. Since the beginnings of transcatheter aortic valve replacement (TAVR) back in 2002, this strategy has gained considerable ground, encompassing not only inoperable or high-risk patients but also those at medium and low risk. Additionally, it came to include patients with failed bioprostheses. The most common reason for surgery was paravalvular leak,…
Does Surgeon (Instead of Operator) Experience Affect TAVR?
There is a correlation between the volume of conventional surgical aortic valve replacement procedures and better outcomes in transcatheter aortic valve replacement (TAVR), with higher 30-day and 1-year mortality in sites with lower volume. This is a probable indication that a good surgical team is complemented by a good hemodynamic team and, ultimately, a good…
Crest-2 Registry: Carotid PCI Presents Low Rates of Death and Stroke
Courtesy of Dr. Carlos Fava. In modern studies, carotid artery stenting (CAS) has been shown equal to surgery in terms of the composite end point of periprocedural stroke, death, acute myocardial infarction and late ipsilateral stroke. This was tested in different groups and by trained operators. In the CREST-2 Registry (C2R) 2141 patients were included,…
Can We Treat Severe Residual Mitral Regurgitation after MitraClip without Surgery?
Courtesy of Dr. Carlos Fava. Edge to edge with MitraClip was shown effective and safe, and its outcomes have been improving over these past few years. However, one of its greatest challenges involves not being able to reduce mitral regurgitation (MR) after device implantation, resulting in the need for surgery, as some studies have shown…
The Significance of Aetiology on Mitral Regurgitation
Courtesy of Dr. Carlos Fava. The aetiology of mitral regurgitation (MR) may be divided into primary, organic or degenerative MR, and secondary or functional MR. These two present different physiopathology. The treatment strategy is different for each, and edge-to-edge treatment with Mitraclip is currently emerging as a valid alternative for high-risk patients. This study analyzed 943 patients…
How long should we wait with asymptomatic aortic stenosis and preserved LVEF?
Courtesy of Dr. Carlos Fava. Asymptomatic severe aortic stenosis with preserved ventricular function is challenging. At present, it remains unclear whether we should operate or not and, according to some recent reports, neither do we know what patients will benefit from surgery. The study looked at 1678 patients with asymptomatic or minimally asymptomatic severe aortic…
Good Outcomes for MitraClip “Off Label”
Courtesy of Dr. Carlos Fava. Mitral regurgitation is the most frequent type of valve disease, accounting for >6% of patients over 65 years old. Surgery is currently the strategy of choice, but percutaneous treatment is a valid alternative. The long-term progress of symptomatic patients at high surgical risk who do not meet the formal indications for…