Cerebral Protection Devices during TAVR in the Daily Practice
The theory behind the use of cerebral protection devices during TAVR is good, but hard to test. The daily practice provides a far bigger number of patients, and therefore might be able to better show how to prevent one of the hardest events during TAVR. This study resorted to Germany’s TAVR database between 2015 and…
TAVR vs. the Least Invasive Surgically Implanted Valve
Rapid-deployment surgically implanted valves are designed to make a surgeons’ job faster and easier, compared with conventional bioprostheses, which require several stitches. These valves, which shorten surgical times, could compete with transcatheter-implanted valves (transcatheter aortic valve replacement, TAVR). The German Aortic Valve Registry analyzed 16,473 patients who underwent surgical aortic valve replacement with either a current-generation…
The Best Anticoagulant Agent for AF After TAVR
Direct anticoagulant agents were associated with lower long-term mortality in patients with atrial fibrillation (AF) discharged after transcatheter aortic valve replacement (TAVR), compared with classic vitamin K antagonists. The purpose of this paper published in JACC Interv was to compare long-term results between classic vitamin K antagonists and novel direct anticoagulant agents in patients with…
Silent Stroke During TAVR and Early Cognitive Impairment
Silent stroke is common after transcatheter aortic valve replacement (TAVR). Co-morbidities such as diabetes or chronic renal failure, as well as procedural factors such as pre-dilation, increase the risk of silent stroke. While many events of silent stroke have an early effect on cognition, it is necessary to learn whether the impairment is sustained over…
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…
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…
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…
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…
AAS vs Warfarin in Low Risk TAVR
We are still discussing the adequate antithrombotic scheme after transcatheter aortic valve replacement (TAVR). Additionally, we are treating a much wider array of patients ranging from low risk to inoperable. And there is yet one more important point: hypo-attenuated leaflet thickening diagnosed by CT. We are still unaware of the impact they have on device…