The ADVANCE study was designed to evaluate the safety and effectiveness of transcatheter aortic valve replacement (TAVR) with self-expanding prosthesis CoreValve in “real world” patients with symptomatic, severe aortic stenosis at high surgical risk. Patients were enrolled from 44 experimental centers in 12 countries; treatment approach and choice of anaesthesia were determined by the local Heart Team.…
An Important Study Shows That Renal Function Must Be Cared for in TAVR
Courtesy of Dr. Carlos Fava. The presence of renal dysfunction in the “real world” is over 25% in patients who undergo transcatheter aortic valve implantation (TAVI). The evolution of this disease among patients who are subjected to a replacement is well known, but evidence for patients who undergo TAVI is still limited, particularly for those who…
REPRISE III: Need for Pacemaker and Paravalvular Leak with Lotus
A recent presentation at London Valves took a closer look at the REPRISE III trial as regards two points that generated much discussion, such as need for a pacemaker and paravalvular leak. REPRISE III had previously demonstrated that the Lotus is noninferior to first-generation CoreValve and Evolut R in terms of safety. Additionally, it proved to be superior…
Small Annulus: Should We Start Choosing the Valve?
Courtesy of Dr. Carlos Fava. A small annulus in patients with Severe Aortic Stenosis is a real challenge, since it is associated with post-surgical prosthesis patient mismatch (PPM), which negatively affects prosthesis duration and evolution. TAVR has become a good alternative strategy, with better hemodynamic profile and lower PPM incidence in this group. The present study included 246…
Tricuspid and Bicuspid Valves Present More Coincidences Than Expected
There is more and more positive evidence that new-generation transcatheter valves, originally designed to treat tricuspid aortic valves, work perfectly fine on bicuspid aortic valves. A comparison of computerized tomography (CT) scans obtained before and after the procedure showed that the most commonly used devices appear to reshape the aortic annulus to the same degree…
It Is a Fact: Cerebral Protection in TAVR Has Proved to Reduce Stroke and Death
Cerebral ischemic events after transcatheter aortic valve replacement (TAVR) have been identified as independent predictors of morbidity and mortality. New-generation devices have managed to partially reduce the rate of cerebral events, but it still is around 5.5% at 30 days for patients undergoing TAVR through transfemoral access. First data on cerebral protection devices had only shown…
Conscious Sedation in TAVR: Is It Advisable?
The fundamental advantage offered by transcatheter aortic valve replacement (TAVR) has always been the fact that it is less invasive than surgical valve replacement. So far, most improvements for these devices have derived in less invasiveness (e.g., by improving the profile of the eluting system). However, there are also cases of “deployment” reduction during the…
Additional Benefit from Radial Artery Graft in Myocardial Revascularization Surgery
Used to different extents according to institution, surgeon, and historical time, the radial artery graft is yet to prove whether it can improve the outcomes of myocardial revascularization surgery when added to a single or bilateral internal thoracic artery graft. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral vs. single left internal…
The need for dialysis after TAVR increases mortality
Courtesy of Dr. Carlos Fava. Stage III or higher renal impairment is frequent before TAVR, and the need for new dialysis after the procedure may reach up to 20%. Within that percentage, 5% may require permanent dialysis, which increases mortality up to 9 times at one year. In that sense, factors leading to that complication have not…
Pacemaker Implantation After TAVI Raises Costs But Not the Incidence of Adverse Events
This new meta-analysis did not manage to prove whether permanent pacemaker implantation after transcatheter aortic valve replacement (TAVR) raises the rates of mortality, infarction, or stroke. Implantation could only be associated to a lesser recovery of ventricular function after the procedure, something that had already been observed in previous studies. Patients who required a pacemaker undoubtedly…