The Effects of Transcatheter Aortic Valve Replacement on Mitral Valve Function.

The transcatheter aortic valve replacement (TAVR) procedure provides a way to treat severe aortic stenosis in the large population of patients who are not candidates for surgical aortic valve replacement. Mitral regurgitation is often concomitant to aortic stenosis in these patients due to the high pressure of the left ventricle and long-term damage to the mitral valve. Due to the proximity of the aortic valve to the mitral valve, TAVR can impact the functional status of the mitral valve by affecting left ventricular outlet obstruction and the mitral valve annular shape. As TAVR becomes increasingly prevalent to treat aortic stenosis, consideration into the impact of TAVR on mitral valve function is important in order determine whether patients will be able to undergo mitral valve repair or replacement, whether surgically or percutaneously. In this review, we seek to explore the effect of TAVR on the mitral annular geometry, mitral valve flow, and the impact of TAVR on the mitral valve in the presence of mitral annular calcification.

Novel Oral Anticoagulants in the Peri-Endoscopic Period.

Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. In this review, we provide an overview of the NOACs and current guidelines from international societies regarding the management of patients scheduled to undergo endoscopic procedures who are prescribed these medications. Finally, we offer a perspective on future studies required to adequately investigate and characterize the effects that these drugs have on a patient's risk for bleeding in the peri- and/or postprocedural timeframes.