Courtesy of Dr. Carlos Fava. Self-expanding supraannular aortic valves have proved to be superior to surgery in high-risk patients and noninferior in intermediate-risk patients. However, the current challenge is posed by low-risk, generally younger, patients. In that sense, our purpose is to determine device effectiveness and safety in terms of mortality and stroke rates (which are…
NOTION and UK TAVI Report Good Long-Term Outcomes
Both studies followed beyond 5 years patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement (TAVR). Findings included low rates of significant valve degeneration and failure, in both cases. While data on the long-term degeneration of transcatheter-implanted valves are scarce, follow-up from the NOTION trial of low-risk patients and from the UK TAVI…
Anticoagulation Plays a Controversial Role in TAVR
Men gender, kidney failure and atrial fibrillation are the factors that most affect 3-year mortality after transcatheter aortic valve replacement. On the other hand, surprisingly enough, anticoagulation (mostly indicated for atrial fibrillation) reduces mortality risk – especially the risk of valve deterioration – after TAVR. Should anticoagulation be included in post TAVR protocols? This question…
The Physiopathology Behind Valve Degeneration in TAVR
The degeneration of transcatheter biological valves clearly depends on time and starts with thrombus generation and subsequent histological changes resulting in valve failure (due to regurgitation, stenosis, or both). Thrombus formation is the first change, observed early in computerized tomography (CT) scans after implantation. Most times it is completely asymptomatic, which leaves many of us…
Bundle Branch Block and Need for Permanent Pacemaker, a Major Challenge after TAVR
Courtesy of Dr. Carlos Fava. The development of new valves for TAVR and the increased experienced of operators have significantly decreased paravalvular leak. However, new bundle Branch block (BBB) and the need for permanent pacemaker (PPM) are still relatively high, and their impact and evolution remain controversial. The study looked at 816 patients, 437…
TAVR Is Feasible and Offers Good Outcomes in Patients with Cancer
Courtesy of Dr. Carlos Fava. Oncology patients have been excluded from all studies, but many of them have a life expectancy of over a year or two, and aortic stenosis can pose a problem as regards their treatment. This study analyzed 2744 patients who underwent TAVR. Among them, 222 presented cancer (8.1%). Patients with cancer were younger,…
Percutaneous Closure Systems Are Safe in TAVR and Aneurysms
Courtesy of Dr. Carlos Fava. Currently, one of our medical challenges is to conduct procedures requiring access with large introducer sheaths in a simpler way, without requiring surgical intervention and closing with percutaneous devices while maintaining procedural quality and safety. There are several devices, but they require a learning curve and the only information available comes…
Is Individual Operator Experience Important in TAVR?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has emerged as a successful alternative for inoperable patients and a non-inferior alternative for high- and intermediate-risk patients. While its evolution depending on site experience has been analyzed, there is currently very little information regarding the impact of operator individual experience. This study analyzed 8771 procedures performed…
Acute Coronary Syndromes After TAVR: Frequent and Not All Undergo Coronary Angiography
Approximately 10% of patients who undergo transcatheter aortic valve replacement (TAVR) are readmitted for an acute coronary syndrome after a mean follow-up of 25 months. Male sex, prior coronary artery disease, and (surprisingly and hard to explain) nontransfemoral approach were independent predictors of acute coronary syndrome after TAVR, an event associated with high midterm mortality. While…
Is TAVR at Hospitals Without Backup Cardiovascular Surgery Feasible?
Patients undergoing transcatheter aortic valve replacement (TAVR) at hospitals without cardiovascular surgery available are at significantly higher risk. That in itself is a call for attention; however, a propensity-matched analysis shows that the short- and long-term mortality rates are similar among patients treated at hospitals with and without cardiovascular surgery backup. This debate emerged a…