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.
This study applies L-wave measurements of mid-diastolic trans-mitral flow. Although considered to be a marker of elevated filling pressure or delayed myocardial relaxation, its clinical and prognostic value is yet to be completely elucidated. It has been shown that transcatheter aortic valve replacement (TAVR) induces reverse remodeling and improves diastolic function and prognosis in patients with severe aortic stenosis (AS). Our purpose was to evaluate the prognostic value of L-wave following TAVR. We examined clinical and echocardiographic data of patients undergoing TAVR. L-Wave presence and velocity were recorded at b...
Paradoxical low-flow low-gradient aortic stenosis (P-LFLG AS) is a high-risk yet incompletely understood subset of severe AS,1 for which studies have not uniformly noted improved outcomes after aortic valve replacement.2,3 Several vascular, valvular, and myocardial conditions contribute to low transvalvular flow (LF) across stenosed aortic valves.4 The cumulative burden of LF conditions may affect hemodynamic improvement after transcatheter aortic valve replacement (TAVR) and explain the aforementioned varying survival benefits.
echt R, Fach A, Augenstein T, Frey N, König IR, Vonthein R, Rückert Y, Funkat AK, Desch S, Desch S, Berggreen AE, Heringlake M, de Waha-Thiele S, SOLVE-TAVI Investigators Abstract Background: In clinical practice, local anesthesia with conscious sedation (CS) is performed in roughly 50% of patients undergoing transcatheter aortic valve replacement (TAVR). However, no randomized data assessing the safety and efficacy of CS versus general anesthesia (GA) are available. Methods: SOLVE-TAVI is a multicenter, open-label, 2x2 factorial, randomized trial of 447 patients with aortic stenosis undergoing transfemo...
CONCLUSIONS: This report on TAVR risk assessment within the VA system demonstrates that despite a large proportion of patients classified as prohibitive risk, TAVR was associated with favorable 30-day and 1-year all-cause mortality rates when compared with published outcomes from the STS/ACC TVT registry. PMID: 32737265 [PubMed - as supplied by publisher]
CONCLUSIONS: Aortic valve replacement, either by surgical or transcatheter approach, appears similarly effective and safe for males and females at intermediate surgical risk. Functional status appears to improve most in females after TAVI. PMID: 32715995 [PubMed - as supplied by publisher]
Conclusion Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
ConclusionsWhen comparing the total percutaneous and total surgical treatment, no significant difference in short ‐term safety outcomes or early and late mortality was observed. More evidence is needed to guide the clinical decision.
AbstractBackgroundTransfemoral aortic valve replacement (TAVR) has been studied extensively in patients with improving safety and efficacy in high to intermediate ‐risk patients with aortic stenosis. TAVR has been now approved for patients with low surgical risk.ObjectiveThe purpose of this study is to integrate the evidence from randomized controlled trials (RCT) and large registry data comparing TAVR to surgical aortic valve repair (SAVR).MethodsSeven studies (three RCTs, one post hoc study of a RCT, and three registries) were included. Incidence rate ratios (IRR) of outcomes of interest (overall mortality, 30 ‐day m...
AbstractBackgroundA significant proportion of patients with aortic stenosis (AS) have discordance in severity by mean gradient/peak velocity and aortic valve area. Low gradient aortic stenosis (LG-AS) is defined when the aortic valve area is
The Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial demonstrated the noninferiority of transcatheter aortic valve implantation (TAVI) using a self-expanding bioprosthesis to surgical aortic valve replacement (SAVR) for the primary end point of all-cause mortality or disabling stroke at 2 years in patients with severe, symptomatic aortic stenosis at intermediate risk for surgery.1 The majority of TAVI patients in the SURTAVI trial (84%) received the first generation CoreValve bioprosthesis (Medtronic, Minneapolis, Minnesota).