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Circulating Plasma microRNAs In Systemic Sclerosis-Associated Pulmonary Arterial Hypertension Haemodynamic definitions and updated clinical classification of pulmonary hypertension A new optical coherence tomography-based calcium scoring system to predict stent underexpansion Neoatherosclerosis in Patients With Coronary Stent Thrombosis: Findings From Optical Coherence Tomography Imaging (A Report of the PRESTIGE Consortium) Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart Disease Characteristics of stent thrombosis in bifurcation lesions analysed by optical coherence tomography Utilization and Outcomes of Measuring Fractional Flow Reserve in Patients With Stable Ischemic Heart Disease The impact of downstream coronary stenoses on fractional flow reserve assessment of intermediate left main disease Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation Percutaneous Coronary Intervention For Bifurcation Coronary Lesions.The 15th Consensus Document from the European Bifurcation Club

Editorial2020 Apr 6;S0828-282X(20)30316-0.

JOURNAL:Can J Cardiol. Article Link

Precision Medicine in TAVR: How to Select the Right Device for the Right Patient

G Marquis-Gravel, S Vemulapalli, AW Asgar et al. Keywords: patient selection; TAVR

ABSTRACT

Transcatheter aortic valve replacement (TAVR) represents a first-line option for the treatment of patients with severe symptomatic aortic stenosis across the entire spectrum of surgical risks. Given the expected growth of TAVR procedures in low-risk patients, many factors other than the primary endpoints of pivotal TAVR trials (either death, or the composite of death or stroke) need to be considered during the selection of a treatment strategy. Such factors include the risk of procedural complications (permanent pacemaker implantation, stroke, new-onset atrial fibrillation, vascular complications, etc), device hemodynamic performance and durability (paravalvular leak [PVL], reinterventions), indication for antithrombotic therapy, and patient quality of life. The pivotal TAVR trials have indicated that some complications with TAVR vs surgical aortic valve replacement (SAVR) vary according to the device under study. For example, rates of permanent pacemaker implantation were higher with TAVR vs SAVR in trials evaluating self-expanding valves, but not in the those evaluating balloon-expandable valves. TAVR represents a suitable option for all risk groups, but how do we personalise care and select the most appropriate device for our patients?