In the initial management of patients with stable chronic angina, a non-invasive strategy with cardiovascular MR perfusion imaging seems to provide similar results to invasive strategies. At one year, MACE rate (combination of all cause death, non-fatal infarction and target vessel revascularization) resulted 3.3% for MRI vs. 3.9% for fractional flow reserve (FFR) informed…
Surgery or TAVR in intermediate risk? Results of the SURTAVI Study
Courtesy of Dr. Gustavo Leiva. Transcatheter aortic-valve replacement (TAVR) with the use of a self-expanding prosthesis is superior to medical therapy in patients with severe, symptomatic aortic stenosis in whom surgical aortic-valve replacement has been associated with prohibitive risk. Among patients considered at high risk, TAVR may be an alternative to surgery. The comparative…
Percutaneous Repair of Paravalvular Leaks After TAVR: The Challenge of Identifying Eligible Subjects
Courtesy of Dr. Carlos Fava. This study enrolled 72 patients who underwent transcatheter aortic valve replacement with an Edwards Sapiens valve, and then experienced a leak of at least moderate severity. Fifteen of them underwent a percutaneous leak repair after identification of the leak mostly through the presence of symptoms. Both groups were similar. Patients who…
MANTA Closure Device for large-bore arteriotomy closure: Is It Safe?
Courtesy of Dr. Agustín Vecchia. The number of transcatheter aortic valve replacements (TAVR) and the placement of aortic endoprosthesis and ventricular assist devices, among others, have grown exponentially worldwide in the last few years. In a short time, many of these procedures will surely become the new standard of care. Logically, this growth comes hand in hand…
TAVI Frailty Indices: We Should Start Using Them
Courtesy of Dr. Carlos Fava. Frailty should be taken into account when deciding transcatheter aortic valve implantation (TAVI). Even though several scales of frailty are available, they are yet to be tested in this group, with this strategy. The study analyzed 101 patients, frailty was assessed clinically according to the following tests: Katz index…
Pacing with a 0.035” Guidewire, an Old Technique Coming Back to Simplify TAVR
This study seeks to prove the safety and efficacy of rapid left ventricular pacing through a 0.035” guidewire during aortic valvuloplasty and transcatheter aortic valve replacement (TAVR). Right ventricular temporary pacing placed through venous access during aortic valvuloplasty or during TAVR is time-consuming and, above all, associated with cardiac perforation and tamponade. Since…
Cerebral Protection in TAVR: Does It Improve Cognitive Function?
Neurological complications during transcatheter aortic valve replacement (TAVR) may be reduced with cerebral protection devices; this study was designed to explore that hypothesis. The study enrolled 363 patients undergoing TAVR in 19 sites and divided them in three arms: a safety arm (n = 123), a device imaging arm (n = 121), and a non-device imaging arm (n = 119). The…
Meta-analysis on Cerebral Embolic Protection in TAVR
Cerebral embolic protection is a strategy to prevent embolization of thrombotic or calcific debris during transcatheter aortic valve replacement (TAVR). A number of randomized and controlled studies have tested the safety and efficacy of various devices, though none of them have enough statistical power to show significant differences in end points. While preliminary…
Evolut R: Clinical Results Might Be Better than Those for First-Generation CoreValve
Two recent articles featured in JACC Cardiovascular Interventions showed that short term (at 30 days) outcomes of patients treated with the next-generation self-expanding Medtronic Evolut R valves could present several advantages compared to the original CoreValve, including recapturability. Both analyses reported similar rates of all-cause mortality and stroke. The study carried out by Dr. Jeffrey Popma as…
Post-Dilation of Self-Expanding Valves: Frequency, Usefulness, and Risks
This study explores the impact of balloon post-dilation on studies conducted in the United States assessing the CoreValve self-expandable valve. Procedural details of 3532 patients were examined to determine whether post-dilation was performed after valve implantation. Best practice guidelines recommend post-dilation to improve suboptimal outcomes, being the most frequent alternative for treating moderate or severe…