The beginning of a new era in the field of percutaneous valvular interventions (PARTNER 3 and Evolut Low Risk trials)

In 2002, Cribier performed the first transcatheter aortic valve implantation (TAVI) in an inoperable patient using a transseptal antegrade approach and a balloon-expandable aortic valve prosthesis, demonstrating the feasibility of percutaneous valve implantation. From then on, the favourable effects of TAVI vs. optimal medical treatment and similar outcomes compared to surgical aortic valve replacement (SAVR) in intermediate- to high-risk patients with severe aortic stenosis have been shown by several studies.1 –3 Thanks to the results of these studies, nowadays, this technique is a part of everyday clinical practice in European countries.4,5 However, it is still reserved for patients who are considered high surgical risk patients by a multidisciplinary heart team. On the other hand, technological refinements and procedural simplification have contributed to a growing interest in the use of TAVI in lower risk patients. Thus, recently reported results of PARTNER 3 and Evolut Low Risk trials seems to be particularly important for the understanding of the role of TAVI in those patients.6,7 Both studies were presented during Joint American College of Cardiology/New England Journal of Medicine Late-Breaking Clinical Trials Session on 17 March 2019 and both compared in a randomized fashion TAVI vs. SAVR in patients who had severe aortic stenosis and were at low surgical risk.
Source: Cardiovascular Research - Category: Cardiology Source Type: research

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AbstractBackgroundPatients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis.MethodsAll adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30 ‐day readmissions, and adjusted 1‐year survival were compared between the two cohorts.ResultsThe o...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
AbstractAs patient survival after cardiac transplantation has improved over the course of the last several decades, clinicians are now faced with late complications. This includes aortic stenosis which, traditionally, has been treated with reoperative sternotomy and aortic valve replacement. Transcather aortic valve replacement (TAVR) offers a minimally invasive alternative in this high ‐risk population. A small but growing number of cases of TAVR after heart transplantation in high‐risk patients have been reported in the last 10 years; we now present a case of aortic valve replacement via a transcatheter approach 24 y...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: CASE REPORT Source Type: research
This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS.Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
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 study sought to derive and validate a systematic method enabling AVC quantification using computed tomography angiography (CTA) in patients with AS. METHODS: 134 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. RESULTS...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg 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
tí-Almor J Abstract BACKGROUND: Severe pulmonary hypertension (PH) in patients with aortic stenosis is related to poor prognosis after aortic valve replacement (AVR). Current European PH guidelines recommend adding two different echocardiographic signs to tricuspid regurgitation velocity (TRV) in PH estimation, classifying its probability as "low" (TRV≤2.8m/s), "intermediate" (TRV 2.9-3.4m/s) and "high" (TRV>3.4m/s). Right ventricle (RV) is an important determinant of prognosis in PH. Our aim was to analyze the value of right atrial area>18cm2 and RV/left ventricle rat...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest 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
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