Experts still won’t agree on whether to carry out randomized trial to put an end to this discussion, but it seems clear that balloon expandable TAVR is valid only for certain anatomies. TAVR in real world bicuspid valve populations is associated with similar outcomes at 30 days and one year when compared against cohorts…
TAVR in Low-Risk Patients with “Zero” Mortality and “Zero” Stroke
Transcatheter aortic valve replacement (TAVR) is now the standard of care for patients with symptomatic severe aortic stenosis who are at extreme, high, or intermediate risk for surgery. This multicenter, prospective study (Feasibility of Transcatheter Aortic Valve Replacement in Low-Risk Patients With Symptomatic, Severe Aortic Stenosis) included low-risk patients and was approved by the United…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
Ambulatory Continuous Monitoring in Patients with Left Bundle Branch Block After TAVI
The incidence of arrhythmic events up to a year after implantation is high and involves almost half the patients with complete left bundle branch block following the procedure. Significant bradyarrhythmias occur in up to one-fifth of the patients, half of whom ultimately require a pacemaker. These data support the idea of a cardiac monitoring device…
TCT 2018 | NEOPRO: A Registry for Acurate neo and Evolut PRO
The purpose of this registry was to compare short-term clinical events and echocardiographic findings in two self-expanding valves used with transfemoral access, Acurate neo and Evolut PRO. The registry included a retrospective follow-up of 1551 patients, among whom 1263 received an Acurate neo valve and 288 received an Evolut Pro valve. The procedural success rates according to VARC-2 criteria were…
ESC 2018 | FRANCE-TAVI: Atrial Fibrillation and Anticoagulation Associated to Mortality in TAVR
Some of the many ongoing randomized studies including patients with atrial fibrillation (AF) might finally answer the question on the best antithrombotic scheme post TAVR. According to this registry, in patients undergoing transcatheter aortic valve replacement, independent predictors of death at 3 years are being a man, having moderate to severe kidney failure, and having…
Gradient vs. Flow to Determine Aortic Valve Stenosis Severity before and after TAVR
Pressure loss vs. flow curves offer a fundamental synthesis of fluids dynamics in describing aortic valve physiopathology. Severe aortic stenosis is not just an orifice (as suggested by Gorlin) or a segment that offers dynamic resistance. However, once a new transcatheter valve has been implanted, it will behave purely as a resistor. At dobutamine dose,…
Far from a Being a Pun, Malnutrition Tips the Scales in TAVR
Nutritional status is associated with higher mortality in elderly patients with severe aortic stenosis who require valve replacement, whether through conventional surgical strategy or transcatheter aortic valve replacement (TAVR). Malnutrition is obviously associated with frailty. As an advantage, it can be quite evident to our clinical eye and weighing scales are enough to define it.…
Differences in Debris Captured According to Valve Type
During valve replacement, cerebral protection systems may capture debris in up to 99% of all patients. In over half of them, these particles are >1 mm. The particles captured during procedures in which Evolut R or Lotus valves were used were more and larger compared with those captured with the Sapien balloon-expandable valve. Beyond differences among valves,…
Urgent/Emergent TAVR: A Valid Option
Courtesy of Dr. Carlos Fava. Aortic stenosis with cardiac failure or cardiogenic shock involves high mortality risk at short term. Surgery in these conditions is often unsafe, which leaves us with valvuloplasty, but only as a bridge to some other procedure, seeing as it is effective only for a short time. Few studies have looked into patients undergoing…