Courtesy of Dr. Carlos Fava. The fact that the presence of a complete right bundle branch block (RBBB) increases the risk of bradycardia, high-grade atrioventricular block, and need for a permanent pacemaker (PPM) after TAVR is well-known. The impact of pre-existing complete right bundle branch block has not been well-studied. This article analyses 749 patients enrolled in…
Transapical and Transaortic TAVR: Valid Alternatives to the Transfemoral
Courtesy of Dr. Carlos Fava. The femoral approach has been the gold standard for the transcatheter aortic valve replacement procedure (TAVR); however, it is anatomically unsuitable for an important number of patients, and these require a different approach. At present, there is little evidence in support of the transapical or transaortic access sites as…
Local Anesthesia for TAVR Was Safe and Reduced Hospital Stays
A minimalist approach to transcatheter aortic valve replacement (TAVR) involving local anesthesia appears to have several advantages, according to this new meta-analysis. In addition to shortening times for procedures and lengths of stay in the critical care unit and hospital, lighter sedation may lower the need for transfusions or treatment with inotropes or vasopressors.…
TAVR or Surgery for Intermediate-Risk Patients? (GARY Registry)
New findings from the GARY (German Aortic Valve Registry) registry show that intermediate-risk patients with severe aortic stenosis presented significantly higher mortality at 1 year when treated with transcatheter aortic valve replacement (TAVR) rather than with conventional surgery. Results reflect everyday realities, which might include various bias tipping the scales towards one strategy or the…
Less than 20% of patients that could benefit from TAVR are receiving it
The introduction of transcatheter aortic valve replacement procedures (TAVR) seems to have increased the number of elderly patients hospitalized with severe aortic stenosis, as well as the number of interventions. However, less than one fifth of patients over 85 are intervened, according to a Canadian registry. Given the significant difference in mortality with TAVR,…
TAVR: The Need for a Pacemaker Is Associated with Mortality
Courtesy of Dr. Carlos Fava. After a transcatheter aortic valve replacement (TAVR), the incidence of permanent pacemaker (PPM) implantation ranges from 6% to 30% in different studies, depending on the valve type used. This is due to trauma, ischemia, haemorrhage, and atrioventricular node and infranodal tissue oedema, provoking ventricular dyssynchrony similar to that caused by…
Post-TAVI Definite Pacemaker: How Harmless Is It?
Courtesy of Dr. Carlos Fava. Transcatheter aortic valve replacement (TAVR) has shown ample benefit in different groups, but one of its drawbacks continues to be the need for permanent pacemaker (PPM), which ranges between 5 and 30%. Its long term impact in terms of mortality is still controversial, since some studies associate it with…
Valve Thrombosis After TAVR: Larger-Diameter Valves and No Warfarin as Predictors
There are limited data on the incidence, clinical implications, and predisposing factors of valve thrombosis in patients who underwent transcatheter aortic valve replacement (TAVR). This study aimed at determining such information through multislice computed tomography (CT). This trial included 460 consecutive patients who underwent TAVR with a balloon-expandable Edwards Sapien XT or Sapien 3 (Edwards Lifesciences,…
TAVR in Pure Aortic Regurgitation Is Associated with Lower Mortality Rates
This study summarizes all available evidence on transcatheter aortic valve replacement (TAVR) for the treatment of native pure aortic regurgitation. Surgical replacement is the standard of care for pure aortic regurgitation. However, there are many reports of cases and small studies in which high-risk patients with pure aortic regurgitation were treated with TAVR. …
Transcarotid TAVR Safety: Local or General Anesthesia?
Courtesy of Dr. Agustín Vecchia. Early transcatheter aortic valve replacement (TAVR) was characterized by high vascular complication rates associated to elevated device diameter (e.g. 22-24 Fr. in the first PARTNER) and less operator experience typical of new techniques. This study shows the progress of TAVR field in these last years, the experience gained by…