Between a Rock and a Hard Place: How to Use Antithrombotics in Patients Undergoing Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has become the preferred method for management of severe aortic stenosis in patients who are at high and intermediate surgical risk. Short-term data have been presented from two studies comparing TAVR versus surgical aortic valve replacement (SAVR) in low surgical risk patients. The Placement of Aortic Transcatheter Valves 3 (PARTNER 3) trial compared TAVR using a balloon expandable valve with standard SAVR. The primary endpoint was a composite of all-cause mortality, stroke, or re-hospitalization at 1 year post-procedure.
Source: Radcliffe Cardiology - Category: Cardiology Authors: Source Type: research

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AbstractTwo randomized control trials demonstrated that transcatheter aortic valve implantation was associated with 1 –2 year clinical outcomes comparable or even superior to surgical aortic valve replacement (SAVR) in low surgical risk patients with severe aortic stenosis (AS). However, no previous study has reported the clinical outcomes after SAVR in Japanese patients with low surgical risk. From 3815 consecu tive patients enrolled in the CURRENT AS registry, we retrieved 220 patients who underwent SAVR in reference to the inclusion and exclusion criteria of the PARTNER 3 trial. Age and surgical risk score in...
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research
CONCLUSIONS: In patients who underwent AVR for aortic stenosis, positive intraoperative fluid balance was associated with decreased odds of AKI. Patients developing AKI had increased 30- and 90-day mortality. While the overall incidence was low, increased intraoperative fluid balance was associated with MI and 30-day mortality, while increased ultrafiltration volume was associated with 30- and 90-day morality. Prospective studies are needed to better define proper intraoperative fluid management in patients undergoing cardiac surgery. PMID: 32151580 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Abstract BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) has evolved as an alternative therapy to open AVR in most patients with aortic stenosis. Stroke associated with TAVR can be a devastating complication in the short-term, however, little is known regarding mid-term outcomes. METHODS: All patients undergoing TAVR from 2011-2018 were included. Modified Rankin Scales (mRS) as a measurement of stroke related disability were extracted for patients who had neurologic deficits. RESULTS: A total of 51 (4.3%) patients (out of 1193) developed neurologic events (NE) during study period (32 [2.7%] dis...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
ConclusionBoth TTR ‐ and AL‐CA can accompany severe AS. Parameters solely based on ECG and echocardiography allow for the identification of the majority of CA‐AS. In the present cohort, CA did not significantly worsen prognosis 15.3 months after TAVR.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for severe symptomatic aortic stenosis. Despite advances in device technology and procedural techniques, periprocedural stroke remains a severe complication of TAVR, affecting 2% of patients. The embolization of calcific debris from the degenerated aortic valve and atherosclerotic plaque from the aorta, both of which are manipulated during TAVR, is the likely mechanism of periprocedural stroke. Accordingly, cerebral embolic protection devices (EPDs) have been designed to prevent stroke by sequestering embolic debris during TAVR.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
Publication date: April 2020Source: IJC Heart &Vasculature, Volume 27Author(s): Paola Angela Maria Purita, Luisa Salido Tahoces, Chiara Fraccaro, Luca Nai Fovino, Won-Keun Kim, Cláudio Espada-Guerreiro, Ole De Backer, Morritz Seiffert, Luis Nombela-Franco, Raul Moreno Gomez, Antonio Mangieri, Anna Franzone, Francesco Bedogni, Fausto Castriota, Tiziana Attisano, Lars Søndergaard, Rosana Hernandez Antolin, Giuseppe TarantiniAbstractBackgroundTranscatheter aortic valve replacement (TAVR) has been validated for the treatment of severe symptomatic aortic stenosis in patients at high and intermediate surgical r...
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research
ConclusionsThis initial experience suggests TAVR can be safely performed in patients with BAV achieving similar short-term procedural and clinical outcomes when compared with patients with TAV.Condensed AbstractThe outcomes of 50 patients (8.8%) with bicuspid aortic stenosis (BAV) undergoing TAVR were compared with those of 517 patients (91.2%) with trileaflet aortic valve (TAV) stenosis. Patients with BAV were younger, had higher prevalence of COPD, lower prevalence of CAD, higher BMI and lower STS score. Major complications were similar between the groups, including stroke (2.0% vs. 1.5, P = .567), 30-day all-c...
Source: American Heart Journal - Category: Cardiology Source Type: research
TUESDAY, Feb. 4, 2020 -- There is no significant difference in the incidence of death or disabling stroke at five years among patients with aortic stenosis at intermediate surgical risk who undergo transcatheter aortic valve replacement (TAVR) or...
Source: Drugs.com - Pharma News - Category: Pharmaceuticals Source Type: news
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
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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