A paradigm shift from surgical to transcutaneous aortic valve replacement (PARTNER 3 and Evolut Low Risk trials)

Severe aortic stenosis is a relatively common clinical condition, becoming more common with advancing age, and the traditional treatment has been surgical aortic valve replacement (SAVR). Almost a decade ago transcutaneous aortic valve replacement (TAVR), was introduced as an alternative treatment to medical therapy alone in patients who were considered too high risk for conventional SAVR. A randomized trial published in 20101 showed a dramatic reduction in mortality at 1 year in these patients receiving TAVR in comparison to those only receiving medical therapy. One year later, it was reported that TAVR resulted in superior outcomes to SAVR in patients who were considered high risk but not ineligible for surgery.2 Approximately 5  years later, TAVR was shown to be at least equivalent to SAVR in patients who were intermediate risk for operation.3
Source: Cardiovascular Research - Category: Cardiology Source Type: research

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This study sought to derive and validate a systematic method enabling AVC quantification using computed tomography angiography (CTA) in patients with AS.Methods134 consecutive patients with AS who underwent both NCCT and CTA were included in the study and sub-divided into derivation (n=71) and validation cohorts (n=63). On NCCT, AVC was quantified using Agatston method utilizing the software developed for semi-automatic assessment of coronary calcium. On CTA, mean contrast attenuation of aorta (AortaHU) and standard deviation (SD) was measured in the region-of-interest at level of sinotubular junction.ResultsUsing an adjus...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
Source: Clinical Radiology - Category: Radiology Authors: Tags: Review Source Type: research
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Source Type: research
AbstractAn 83-year-old man had aortic valve replacement for aortic stenosis with a pericardial bioprosthesis and subsequent implantation of a CoreValve ™ prosthesis as a valve-in-valve procedure. Approximately 4 years later, he developed endocarditis on the CoreValve™ with severe prosthetic stenosis, a periannular abscess and systemic embolization. At reoperation both prostheses were removed and another bioprosthesis inserted after reconstruct ion of the aortic root. Endocarditis after transaortic valve implantation is an uncommon event with dismal prognosis. Infection of a self-expandable device as a valv...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
AbstractAortic valvular calcium score (AVCS) can identify severe aortic stenosis (AS) and provide powerful prognostic information. In severe and symptomatic AS, patients can be referred for a transcatheter aortic valve replacement (TAVR). The aim of this study was to determine whether AVCS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with device success (DS), major adverse cardiac events (MACEs) and paravalvular leak (PVL) after TAVR. Three hundred and fifty-two consecutive patients who underwent TAVR with a preoperative standardised contrast enhanced MSCT were includ...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
This study utilized the National Readmissions Database (NRD) to evaluate the impact of malnutrition on mortality, complications, length of stay (LOS), 30-day readmission, and total charges following TAVI. Adult patients undergoing isolated TAVI for severe aortic stenosis were identified using the 2011-16 NRD, which accounts for 56.6% of all US hospitalizations.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Severe aortic stenosis will cut off the systolic BP and hence classical pulsus parvus et tardus occurs. This is what , we have been taught all along. How for it is true?   One thing is clear from clinical observation. Systolic BP need not be low, often its normal even in severe Aortic stenosis. The issue becomes curious when  high BP is associated with severe Aortic stenosis. This can happen by a variety of mechanisms.(Aging/Loss of Aortic elasticity /Pressure recovery/Hypertension)  I think, there have been little correlative studies of pulsus parvus with central aortic pressure. Can Aortic stenosis be a ca...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: aortic stenosis Aortic stenosis and hypertension aortic stenosis causing hypertension hypertension as a cause for aortic stenosis Systolic decapitation in aortic stenosis Source Type: blogs
CONCLUSION: LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated with sAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediately after the TAVR procedure than sAVR. PMID: 31887797 [PubMed - in process]
Source: Yonsei Medical Journal - Category: Universities & Medical Training Authors: Tags: Yonsei Med J Source Type: research
There has been an ongoing evolution in our understanding and subsequent management of the patient with aortic stenosis (AS). Valvular AS presents a mechanical obstruction to ventricular ejection at the aortic valve level, worsens over time, and with the onset of symptoms there is a rapidly declining course resulting in progressive heart failure and death. The advent of surgical aortic valve replacement (SAVR) nearly 60 years ago has been lifesaving for many patients with symptomatic severe AS, restoring quality of life to those with severe limiting symptoms.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Editorial Source Type: research
To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR).
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Original article Source Type: research
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