Future Directions. Transcatheter Aortic Valve Implantation for Low-risk Patients: Inevitable Evolution or a Step Too Far?

Publication date: Available online 28 March 2019Source: Revista Española de Cardiología (English Edition)Author(s): Guy Witberg, Tiffany Patterson, Simon Redwood, Bernard PrendergastAbstractTranscatheter aortic valve replacement has become the treatment of choice for inoperable and high-risk patients with symptomatic aortic stenosis, and is becoming more and more common as the first choice for intermediate-risk patients as well. The next step in this evolution would be the expansion of treatment indications to low-risk patients. Successful treatment of this patient population will require setting new standards in terms of clinical outcomes and cost effectiveness. In this review, we present the main challenges that need to be addressed before transcatheter aortic valve replacement can be applied as a standard treatment for low-risk patients.ResumenEl implante percutáneo de válvula aórtica es actualmente el tratamiento de elección para los pacientes con estenosis aórtica sintomática grave inoperables o con alto riesgo quirúrgico, y su uso cada vez es más habitual para los pacientes con riesgo intermedio. El siguiente paso en esta evolución sería la indicación para los pacientes con bajo riesgo quirúrgico. El tratamiento exitoso de esta población de pacientes requerirá la definición de resultados clínicos y de coste-efectividad adaptados a ella. En esta r...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research

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We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Conclusions: Our center successfully implanted the self-expandable aortic valve Evolut™ through direct aortic for presenting a dissection in transverse aorta with possibilities of embolization. PMID: 31702726 [PubMed - in process]
Source: Archivos de Cardiologia de Mexico - Category: Cardiology Authors: Tags: Arch Cardiol Mex Source Type: research
AbstractBackgroundWhen transcatheter aortic valve replacement (TAVR) was first approved by the Food and Drug Administration in October 2011, it was an innovative treatment with limited accessibility. However, over the past few years, TAVR has become standard of care in patients with aortic stenosis. The effect of socioeconomic status (SES) on this transition of use of TAVR is unknown.MethodUsing the New York state department Statewide Planning and Research Cooperative System database, we compared baseline patient characteristics and facilities in low ‐income areas and high‐income areas. Trends in residential SES of pat...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Transcatheter aortic valve implantation (TAVI) is the current standard of care for patients with severe aortic stenosis (AS) who are at high risk for surgery. However, several recent studies have demonstrated the comparable safety and efficacy of TAVI in low-risk patients as well. We sought to pool the existing data to further assert its comparability. MEDLINE, Cochrane, and Embase, databases were evaluated for relevant articles published from January 2005 to June 2019. Studies comparing outcomes of TAVI versus surgical aortic valve replacement (SAVR) in patients who are at low risk for surgery were included.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Transcatheter aortic-valve replacement (TAVR) has emerged as a promising strategy for treating patients with severe aortic stenosis. We aimed to compare TAVR with surgical aortic-valve replacement (SAVR) and determine the performance of TAVR over time and within several subgroups. We included 8 randomized trials comparing TAVR vs. SAVR. Compared with SAVR, TAVR was associated with a lower rate of all-cause mortality or disabling stroke at 30-day (odds ratio [OR], 0.72; P=0.004), 1-year (OR, 0.83; P=0.01) and 2-year (OR, 0.86; P=0.02), but not at long-term follow-up (rate ratio [RR], 1.02 [CI, 0.92 to 1.13]; P=0.67).
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
ConclusionsMIAMVS can be performed via a right mini ‐thoracotomy, with acceptable early and midterm results expected. This may be a feasible alternative to the standard median sternotomy approach.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
AbstractBackground and Aim of the StudyWe compared early and late outcomes of surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and pulmonary hypertension (PHT).MethodsWe searched MEDLINE and EMBASE databases until July 2018 for studies comparing patients with AS and none, mild ‐moderate, or severe PHT undergoing SAVR. Random‐effects meta‐analysis was performed.ResultsThere were 12 observational studies with 70  676 patients with median follow‐up 4.0 years (interquartile range, 2.6‐4 years). Compared to patients with no PHT, patients with any PHT undergoing SAVR were older (mea...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: REVIEW ARTICLE Source Type: research
Transcatheter aortic valve replacement (TAVR) has been increasingly utilized as an intervention for the management of symptomatic intermediate and high risk severe aortic stenosis, and utilization rates are expected to increase exponentially worldwide.1,2 One of the most frequent complication of TAVR is the development of New-onset Atrial Fibrillation (NOAF), with an estimated incidence ranging from 16% to 51.1%.3 NOAF corresponds to the detection of atrial fibrillation (AF) during or after the TAVR procedure in a patient without previously known AF.
Source: Heart and Lung - Category: Intensive Care Authors: Source Type: research
Publication date: November 2019Source: Canadian Journal of Cardiology, Volume 35, Issue 11Author(s): Anita W. Asgar, Maral Ouzounian, Corey Adams, Jonathan Afilalo, Stephen Fremes, Sandra Lauck, Jonathan Leipsic, Nico Piazza, Josep Rodes-Cabau, Robert Welsh, Harindra C. Wijeysundera, John G. WebbAbstractTranscatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at i...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Trans-catheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) in high and intermediate risk patients with aortic stenosis. TAVR programs are spreading from large referral centers and being established in community based institutions. The purpose of this study was to compare the outcomes of TAVR to those of SAVR in a community hospital. A historical cohort study of patients with aortic stenosis and pre-post procedure echocardiography data who underwent SAVR or TAVR in Cape Cod Hospital between January 2014 and December 2016. Patient characteristics and procedure outcom...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
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