There has been a significant decline in vascular complications in the last few years due to improvements in device profiles and operator experience on transcatheter aortic valve replacement (TAVR). Unilateral vascular access for transfemoral TAVR is as safe as bilateral access and it could be more comfortable for patients according to this study recently published…
Pre-TAVR Revascularization: Angiographic or Physiological?
In patients undergoing transcatheter aortic valve replacement (TAVR), fractional flow reserve (FFR) guided revascularization is associated with favorable results compared against the traditional angiography guided revascularization. Given the complete lack of randomized studies, this observational study is the best we have to decide how to guide revascularization in patients with symptomatic severe aortic stenosis undergoing…
AHA 2019 | Sapien vs Evolut: A Head-to-Head Study Seems Mandatory
Two French registries have carried out a propensity matched comparison which suggest differences between balloon-expandable valves (BEV) and self-expandable valves (SEV) in hard end points such as mortality. The only FDA approved commercially available transcatheter heart valves in the US are the BE Sapien 3 (Edwards Lifesciences) and the SE CoreValve Evolut PRO (Medtronic). Both…
Lower Mismatch Rate with the New Self-Expandable Valves
Prosthesis mismatch (PPM) was introduced by Rahimtoola in 1978 and happens when the effective orifice area of a heart valve prosthesis is too small in relation to patient body size. Surgical valves have been well documented, but there is little information on percutaneous valves. The study looked at 757 patients undergoing TAVR with pre and post procedural eco-Doppler…
AHA 2019 | GALILEO: Rivaroxaban After TAVI, Another Nice Theory that Clashes with Reality
In patients without formal indication for oral anticoagulation after successful transcatheter aortic valve implantation (TAVI), a treatment strategy including rivaroxaban 10 mg daily was associated with a higher risk of death or thromboembolic complications and, on top of that, a higher risk of bleeding than a conventional antiplatelet strategy. So far, we did not know whether…
AHA 2019 | GALILEO-4D: Rivaroxaban in the Prevention of Post TAVR Valve Thickening and Thrombosis
This sub study of the GALILEO specifically looked at valve thickening and reduced leaflet motion after TAVR documented with 4D CT. Whether anticoagulation with rivaroxaban might reduce or prevent this phenomenon remained unanswered. Patients receiving the same anticoagulation scheme than the general study’s (rivaroxaban + aspirin vs. aspirin + clopidogrel) were assessed by 4D CT…
Temporal Trends and Outcomes of TAVR in Bicuspids: Are We Any Better?
This large registry has shown bicuspid aortic stenosis (AS) patients have similar mortality with transcatheter aortic valve replacement (TAVR) compared against surgical valve replacement (SAVR). TAVR outcomes in this population are not only similar to SAVR outcomes, but also to TAVR outcomes in patients with conventional aortic valve anatomy. Despite the good news, these outcomes…
Europe Grants Approval to Balloon-Expandable Valve in Low-Risk Patients; Self-Expanding Valve Still Waiting for It
The balloon-expandable valve has been granted approval in Europe for treatment of the complete risk spectrum of symptomatic severe aortic stenosis. Europe has recently approved an expanded indication for the Sapien 3 system for use in low-risk patients, as reported by Edward Lifesciences. Sapien 3, which includes the next-generation Sapien 3 Ultra, is the first transcatheter heart valve…
Negative Impact of Pulmonary Hypertension in TAVR
Courtesy of Dr. Carlos Fava. The presence of pulmonary hypertension (PH) is frequent in severe aortic stenosis. This can be classified in: isolated pre-capillary PH, isolated post-capillary PH, and combined post-capillary and pre-capillary PH. At present, little research has looked into the disease from this perspective. The study looked at 1400 patients and divided them…
Infective Endocarditis After TAVI
Infective endocarditis after transcatheter aortic valve implantation (TAVI) is one of the most feared complications due to its morbidity and mortality. With the expansion of TAVI into all risk groups, endocarditis might be a long-term concern. However, its long-term risk seems similar to that of endocarditis with surgically-implanted biological valves; consequently, it should not affect…