TAVR has shown benefits in high risk patients (prohibitive) and in intermediate risk patients, but the need for permanent pacemaker implantation (PPI) continues to be a soft spot (especially in younger patients) given time of use, eventual replacement and associated complications. Even though there is little information on PPI, pacemakers are not associated with higher mortality, but they…
Next-Day Discharge after TAVR: Is It Viable?
Next-day discharge after transfemoral transcatheter aortic valve replacement (TAVR) might be viable, with no major complications at 30 days or one year, compared against patients with longer hospital stay. We only have to consider a few factors that will help us choose the most adequate patients for this modality without compromising safety. One of the main advantages…
Red Light for TAVR in Low Surgical Risk Patients
A new study raises an alarm against expanding transcatheter aortic valve replacement (TAVR) procedures to low surgical risk patients, since 2 year mortality seems higher in these patients with TAVR, compared to conventional surgery. This study will soon be published in Catheter Cardiovasc Interv. Expanding TAVR to low risk patients might involve risks we have not…
Is Emergency Cardiac Surgery Necessary in TAVR?
Life-threatening complications that require surgery during TAVR are infrequent. The proportion was originally thought to be between 1% and 2%. However, we now know that it is lower, even though we do not know how frequent it is or what are its most common causes. Its evolution, both in the short and in the long…
Coronary Disease Works as a 30-Day Predictor in TAVR
The association between aortic stenosis and coronary disease is common, since both conditions share pathogenesis, risk factors, and symptoms. Transcatheter aortic valve replacement (TAVR) is currently indicated for high-risk and inoperable patients. It also appears as a valid alternative for the treatment of intermediate-risk patients, and it could soon be indicated for low-risk patients. Coronary…
Leading Manufacturer of Balloon-Expandable Valves Launches Self-Expanding Device
Edwards Lifesciences could have been satisfied after the success of the PARTNER trials and the improvements to its balloon-expandable valve (mainly as regards the delivery system profile and paravalvular leak reduction) in its last model, SAPIEN 3. However, it was not. The company decided to keep going, developing a valve that is radically different from its…
Mild Leaks: TAVR’s Silent Enemies
Courtesy of Dr. Carlos Fava. Even though the presence of paravalvular regurgitation (PVR) has been reduced, thank to greater experience and new devices, it is still frequent and has an impact in survival (especially moderate and severe PVR). Recent research has shown that mild PVR also has a negative impact. However, these data were provided…
Who Lives Longer After TAVR, Men or Women?
Courtesy of Dr. Carlos Fava. Currently, some small observational studies and a meta-analysis suggest that women experience more short-term complications after TAVR (due to higher rates of bleeding, vascular complications, and stroke), as well as less 1-year mortality. However, results are still conflicting. This work analyzed 17 studies including 8 different registries, with a total 23,303 women and 23,885 men.…
WIN TAVI: The Largest Female TAVR Registry So Far
Courtesy of Dr. Carlos Fava. In most randomized or observational studies, women comprise more than 50% of patients undergoing TAVR, and they have showed better evolution, compared against surgery. The main differences between men and women with severe aortic stenosis are that women have smaller annular dimension, shorter distance to coronary ostia, smaller peripheral arteries, and…
Lotus Valve in Real Life Patients: the near total lack of leaks is its greatest strength
Even though the incidence of complications in transcatheter aortic valve replacement (TAVR) have significantly decreased, there is one in particular that remains a concern since, when mild, it is associated to increased events rate. This complication is prosthetic paravalvular leak , which happens between the native annulus and the stent. The Lotus valve, completely repositionable, uses a…