'Why we do What we do in Cardiology'

Valvular HD: 2023 Structural Highlights

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Focus on Valves:

  • TAVI vs. SAVR: Long-term data showed mixed results. PARTNER 3 (Sapien 3 valve) benefits declined over time, while Evolut Low Risk (CoreValve, Evolut R/PRO) favoured TAVI. Experts advise caution in direct comparison.
  • Aortic Regurgitation: The ALIGN-AR trial demonstrated the success of the Trilogy valve for moderate-to-severe AR, with improved symptoms and quality of life.
  • Ross Procedure: Analysis showed excellent long-term survival (25 years) for patients undergoing the Ross procedure.
  • Mitral Regurgitation: The CLASP IID trial showed similar outcomes for MitraClip and Pascal devices in high-risk patients with degenerative MR, with sustained improvements.
  • Tricuspid Regurgitation: TRILUMINATE Pivotal trial showed significant TR reduction and quality-of-life improvements with TriClip TEER but no mortality or heart failure hospitalization reductions. Additional analyses provided further insights.
  • TTVR: The TRISCEND II trial found that Evoque valve + therapy offered near-complete TR elimination and symptom improvements, which was hailed as a significant advancement.

    • Challenges and Future Directions:

    • Lead Jailing: Electrophysiologists call for improved communication between fields to address potential damage to pacemaker/defibrillator leads during tricuspid interventions.
    • Areas to hear more in 2024: 
      1. Long-term data from low-risk TAVI trials.
      2. TTVR as an alternative treatment option for tricuspid valve disease.
      3. Expanding M-TEER with multiple device options.
      4. Artificial intelligence applications in structural heart interventions.
      5. Novel devices and research, including TAVI-in-TAVI procedures.

        6. Overall, 2023 was a pivotal year for structural heart disease, with advancements in valve interventions and promise for future innovation.


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        'Why we do What we do in Cardiology'By Bishnu Subedi

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