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Coronary Access Following Redo TAVR: Impact of THV Design, Implant Technique, and Cell Misalignment

The implications and potential challenges of coronary access after redo transcatheter aortic valve replacement (TAVR) are unknown. The authors sought to evaluate the impact of different transcatheter heart valve (THV) ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S193687982200927X?via=ihub



Conclusions: This study demonstrates that different redo TAVR combinations are not equivalent in terms of future coronary access. Redo TAVR using a tall frame valve in a failed tall frame valve and misaligned cells may lead to potentially challenging coronary access.

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Cost-effectiveness of transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis of intermediate surgical risk in Singapore - BMC Health Services Research

Objective The objective was to assess the cost-effectiveness of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis with intermediate surgical risk in Singapore. Methods A de novo ..... see more

Source : https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08369-5



Conclusion: TAVI is unlikely to be cost-effective in intermediate surgical-risk patients compared to SAVR in Singapore.

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Comparison of outcomes of trans-subclavian versus trans-apical approaches in transcatheter aortic valve implantation - Journal of Cardiothoracic Surgery

Background Many patients are unsuitable for conventional femoral transcatheter aortic valve implantation (TAVI) but there is limited evidence as to which alternative approach has the best outcomes. We compared clinical ..... see more

Source : https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-022-01929-0



Conclusions: Both trans-subclavian and trans-apical access are viable approaches for patients requiring non-transfemoral TAVI. Differences in peri-procedural indices reflect the disparate patient populations and factors governing prosthesis choice, and short- and long-term mortality was similar.

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Conclusions: During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and...

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Surgical aortic valve replacement provides better left ventricular mass regression than transcatheter aortic valve replacement in patients with small aortic annulus - General Thoracic and Cardiovascular Surgery

Objectives This study aimed to evaluate the incidence of patient-prosthesis mismatch (PPM) and degree of left ventricular (LV) mass regression after surgical aortic valve replacement (SAVR) and transcatheter aortic valve ..... see more

Source : https://link.springer.com/article/10.1007/s11748-022-01858-8



Conclusions: SAVR provides better LV mass regression than TAVR with a comparable rate of PPM in patients with small aortic annulus.


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Direct oral anticoagulants or vitamin K antagonists after TAVR: A systematic review and meta-analysis

Several patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral ..... see more

Source : https://www.internationaljournalofcardiology.com/article/S0167-5273(22)01109-3/fulltext



Conclusion: Considering the totality of available evidence, in patients underwent TAVR with a concomitant indication for OAC, DOACs-based strategy is an effective and safe anticoagulation strategy compared to VKA.

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Standardized Definitions for Bioprosthetic Valve Dysfunction Following Aortic or Mitral Valve Replacement: JACC State-of-the-Art Review

Both surgical and transcatheter aortic and mitral bioprosthetic valves have limited durability and are prone to structural valve deterioration. * Consideration only of valve-related reintervention or death underestimates the incidence ..... see more

Source : https://www.sciencedirect.com/science/article/pii/S0735109722051622?via=ihub



Relevance: The main objective of this expert consensus document is to propose or complement standardized definitions and measurement methods of: nonstructural and structural BVD and BVF following aortic or mitral biological valve replacement. These definitions should support standardized reporting in research and help guide clinical practice.

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Conclusion: MCOT for ambulatory cardiac monitoring post-TAVR discharge is associated with higher rates of pacemaker insertion, at no overall greater costs.

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Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification - PubMed

doi: 10.1093/eurheartj/ehac377. Online ahead of print. 1 Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 2 Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35869873/


Conclusion/Relevance: In the population-based Rotterdam Study, Lp(a) is robustly associated with baseline and new-onset AVC but not with AVC progression, suggesting that Lp(a)-lowering interventions may be most effective in pre-calcific stages of aortic valve disease.

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A Sharp Right Turn: A Case of Aortic to Right Atrial Fistula During Transcatheter Aortic Valve Replacement - PubMed

BACKGROUND Aorto-atrial fistulas (AAFs) are rare lesions typically associated with paravalvular abscesses or aortic aneurysms. Iatrogenic AAFs have been described after cardiac surgery. While these lesions are often asymptomatic, they ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35862296/


Conclusions: This case represents the first full report of an aorta to right atrial fistula after TAVR. The anatomy of the aortic root in relation to the right atrium and ventricle may make aorta to right ventricle fistulas more common than aorta to right atrial fistulas. This patient’s vascular tortuosity may have played a role in the...

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Conclusions: Patterns of reverse remodeling differ from lone AS to AS-ATTR, with both groups experiencing symptomatic improvement by TAVR. After AS treatment, AS-ATTR transfers into a lone ATTR cardiomyopathy phenotype.




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Phenotyping the hypertensive heart - PubMed

Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35869979/



Conclusion:Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.

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The impact of frailty on adverse outcomes after transcatheter aortic valve replacement in older adults: A retrospective cohort study - PubMed

doi: 10.1002/ccd.30320. Online ahead of print. 1 Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands. 2 Department of Cardiology, University Medical Centre Utrecht, Utrecht University, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35830708/


Conclusion: Frailty is common in TAVR patients and is associated with an increased overall risk of postoperative complications, particularly mortality. Increased optimization of screening and treatment of frailty in the guidelines for valvular heart diseases is recommended.

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Direct Comparison of Outcomes After Transcatheter Aortic Valve Replacement in Veterans and Non-Veterans Using the Transcatheter Valve Therapy Registry - PubMed

The affiliation between a VAMC and an academic medical center allowed for direct comparison between veterans and non-veterans undergoing TAVR by the same operators using the TVT registry. Despite significantly ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35830359/



Conclusions: The affiliation between a VAMC and an academic medical center allowed for direct comparison between veterans and non-veterans undergoing TAVR by the same operators using the TVT registry. Despite significantly higher rates of comorbidities, veterans had equivalent outcomes compared with non-veterans. This may be in part due to...

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Main pulmonary artery diameter in combination with cardiovascular biomarkers. New possibilities to identify pulmonary hypertension in patients with severe aortic valve stenosis? - Minerva Medica 2022 Jul 13

Original Article DOI: 10.23736/S0026-4806.22.08167-8 Copyright © 2022 EDIZIONI MINERVA MEDICA language: English Main pulmonary artery diameter in combination with cardiovascular biomarkers. New possibilities to identify pulmonary hypertension in patients with ..... see more

Source : https://www.minervamedica.it/en/journals/minerva-medica/article.php?cod=R10Y9999N00A22071301



Conclusions: The MPA diameter remains a controversial parameter for the detection of PH in patients with severe AS. Standing on its own, this non-invasive parameter may not be precise enough to detect PH accurately. Combining this parameter with several biomarkers did not provide significant additional information.


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Tips and tricks for successful trans-EVAR TAVR: Buddy up!

Available online 4 July 2022 83-year-old patient with severe symptomatic aortic stenosis (New York Heart Association 3) was evaluated for aortic valve replacement. His aortic valve area and aortic valve ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S1553838922006224?via=ihub



Relevance: Although trans-EVAR TAVR remains somewhat unpredictable, especially these 4 strategies may simplify and reduce the inherent failure rate of such procedures.

Krishna Moorthy, STEVE NOZAD Commented on a Post
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TAVR Suitability in the Low-Risk Patient

72-year-old hypertensive woman with a family history of coronary artery disease presents with a 3-month history of functional class II dyspnea on exertion (New York Heart Association). The patient has an active lifestyle and plays pickleball 4 x/week with friends. She is currently taking lisinopril 5 mg every day. She complains of neither chest pain nor palpitations.

Physical exam findings

  • Pulse: 88 bpm
  • Respiration rate: 19/min
  • Blood pressure: 110/80 mmHg without orthostatic changes
  • Heart sounds: midsystolic ejection murmur heard best at the right upper sternal border

Results from her CBC and CMP were within normal limits.

On echo, there is a mean gradient 42 mmHg, peak aortic velocity of 4.1 m/s, and aortic valve area of 0.9 cm2. Results from the CCT confirmed severe aortic stenosis.

Her Society of Thoracic Surgeons risk is 1.8%. Her projected life expectancy is about 15 years. During patient visit, she expressed a preference for TAVR vs SAVR.

Based on this information, what interventions do you anticipate could be recommended for this patient? What information would you need to decide on TAVR or SAVR for this patient? Would you rather defer this patient to a heart-team to make the treatment decision?

Show More Comments

  • July 17, 2022
    refer to tavr team for evaluations and consider tavr
  • July 15, 2022
    Patient needs to have PCI to see if patient has a coronavirus disease or not before to do any intervention
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TAVR in an XXXL annulus (1057 mm 2 ) with type I bicuspid aortic valve - PubMed

We report the largest annulus (>1000 m 2 ) treated with transcatheter aortic valve replacement to date. It highlights the unique challenges in planning, sizing, and deployment considerations in the ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35791643/


Relevance: We report the largest annulus (>1000 m2) treated with transcatheter aortic valve replacement to date. It highlights the unique challenges in planning, sizing, and deployment considerations in the setting of a very large and altered geometry of a bicuspid aortic valve.

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Comparison of outcomes after transcatheter aortic valve replacement between elderly (65-79 years) and super-elderly (≥80 years) patients - PubMed

Transcatheter aortic valve replacement (TAVR) is an effective treatment option for patients with severe symptomatic aortic stenosis. Nonetheless, there is a paucity of data regarding the differences in the clinical ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35777026/


Conclusion: TAVR was associated with similar safety outcomes in the EG (65–79 years) and the SEG (≥80 years). Advanced age is not negatively associated with clinical outcomes after the TAVR procedure.

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Protamine-induced acute thrombosis in a post-TAVR patient: A word of caution

Available online 10 June 2022 Major vascular complications after sulfate (PS) that was administered to mitigate a bleeding complication post-failure of a transcatheter aortic valve replacement (TAVR) are a pertinent ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S1553838922003001?via=ihub



Conclusion/Relevance: PS should be used cautiously for the prevention or management of bleeding-site complications following TAVR. The patient described in this case has consented to having his case described in this manuscript.