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Recommendations for aortic valve replacement

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https://www.readbyqxmd.com/read/29149323/should-the-dilated-ascending-aorta-be-repaired-at-the-time-of-bicuspid-aortic-valve-replacement
#1
Tsuyoshi Kaneko, Prem Shekar, Vladimir Ivkovic, Nicholas T Longford, Chuan-Chin Huang, Martin I Sigurdsson, Robert C Neely, Maroun Yammine, Julius I Ejilofor, Vanessa Montiero Vieira, Jasmine T Shahram, Karam M Habchi, Gregory W Malzberg, Peter S Martin, Jordan Bloom, Eric M Isselbacher, J Daniel Muehlschlegel, Thoralf M Sundt, Simon C Body
OBJECTIVES: Bicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes...
November 14, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29130587/pushing-boundaries-implantation-of-the-34-mm-medtronic-corevalve-in-patients-with-a-large-aortic-annulus
#2
Adham Elmously, Berhane Worku, S Chiu Wong, Arash Salemi
The relationship between adherence to the recommended CoreValve sizing parameters and clinical outcomes is not well known for the recently released 34 mm valve, which is currently the largest available transcatheter valve. There is a presumed temporal reduction in paravalvular regurgitation in patients who receive an in-range valve, however, certain patients possess annular dimensions that are too large. We therefore describe two patients with annular dimensions larger than the manufacturer recommended range for the 34 mm CoreValve, who despite this underwent transcatheter aortic valve replacement with excellent clinical outcomes...
November 11, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29101983/acr-appropriateness-criteria-%C3%A2-imaging-for-transcatheter-aortic-valve-replacement
#3
Jonathon A Leipsic, Philipp Blanke, Michael Hanley, Juan C Batlle, Michael A Bolen, Richard K J Brown, Benoit Desjardins, Robert T Eberhardt, Heather L Gornik, Lynne M Hurwitz, Hersh Maniar, Himanshu J Patel, Elizabeth F Sheybani, Michael L Steigner, Nupur Verma, Suhny Abbara, Frank J Rybicki, Jacobo Kirsch, Karin E Dill
Aortic stenosis is a common valvular condition with increasing prevalence in aging populations. When severe and symptomatic, the downstream prognosis is poor without surgical or transcatheter aortic valve replacement. Transcatheter aortic valve replacement is now considered a viable alternative to surgical aortic valve replacement in patients considered high and intermediate risk for surgery. Pre-intervention imaging with echocardiography and CT are essential for procedure planning and device selection to help optimize clinical outcomes with MR angiography playing largely a complementary role...
November 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29064293/transcatheter-aortic-valve-implantation-where-are-we-now
#4
Mark Mariathas, John Rawlins, Nick Curzen
Transcatheter aortic valve implantation (TAVI) was first used in clinical practice in 2002. Since 2002, there has been a rapid increase in TAVI activity in patients with symptomatic severe aortic stenosis. This has been supported by systematic randomized data comparing TAVI against the gold standard treatment for the last 50 years' surgical aortic valve replacement. TAVI is now currently a recommended therapeutic intervention in the treatment of severe aortic stenosis patients who are deemed either high risk or inoperable...
October 24, 2017: Future Cardiology
https://www.readbyqxmd.com/read/29029058/inter-ethnic-differences-in-valve-morphology-valvular-dysfunction-and-aortopathy-between-asian-and-european-patients-with-bicuspid-aortic-valve
#5
William K F Kong, Madelien V Regeer, Kian K Poh, James W Yip, Philippe J van Rosendael, Tiong C Yeo, Edgar Tay, Vasileios Kamperidis, Enno T van der Velde, Bart Mertens, Nina Ajmone Marsan, Victoria Delgado, Jeroen J Bax
Background: Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of inter-ethnic differences in valve morphology and function and aortic root dimensions in patients with BAV is important for the worldwide spread of this therapy in this subgroup of patients. Comparisons between large European and Asian cohorts of patients with BAV have not been performed, and potential differences between populations may have important implications for TAVR...
October 6, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29020347/transcatheter-aortic-valve-implantation-in-lower-risk-patients-what-is-the-perspective
#6
Giuseppe Tarantini, Luca Nai Fovino, Bernard J Gersh
In the last decade, transcatheter aortic valve implantation (TAVI), a disruptive technology, has revolutionized the therapy of symptomatic severe aortic stenosis, and current guidelines state that the recommendations for TAVI and surgical aortic valve replacement (SAVR) are equivalent in patients at high-risk. Increased operator experience, technical advances in the new generation of transcatheter heart valves (THV) and excellent TAVI results in recently published randomized controlled trials have led to the expansion of TAVI indication as an alternative to SAVR in intermediate-risk subjects, given appropriate patient selection...
August 24, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28962508/replica-sizing-strategy-for-aortic-valve-replacement-improves-haemodynamic-outcome-of-the-epic-supra-valve
#7
David Gonzalez-Lopez, Gloria Faerber, Mahmoud Diab, Paulo Amorim, Natig Zeynalov, Torsten Doenst
OBJECTIVES: Current sizing strategies suggest valve selection based on annulus diameter despite supra-annular placement of biological prostheses potentially allowing placement of a larger size. We assessed the frequency of selecting a larger prosthesis if prosthesis size was selected using a replica (upsizing) and evaluated its impact on haemodynamics. METHODS: We analysed all discharge echocardiograms between June 2012 and June 2014, where a replica sizer was used for isolated aortic valve replacement (Epic Supra: 266 patients, Trifecta: 49 patients)...
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28957996/meta-analysis-of-sutureless-technology-versus-standard-aortic-valve-replacement-and-transcatheter-aortic-valve-replacement
#8
Saqib H Qureshi, Anas Boulemden, Adam Szafranek, Hunaid Vohra
OBJECTIVES: Aortic valve replacement (AVR) using sutureless technology is a feasible alternative in surgical patients. Comparative evidence against established strategies such as conventional AVR and transcatheter AVR is lacking, limiting the assessment of safety and efficacy. METHODS: Medline search for available evidence was undertaken. The outcomes analysed were 30-day mortality, risk for stroke, myocardial infarction, renal failure, paravalvular leak and need for permanent pacemaker...
September 12, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28943264/could-anticoagulation-avoid-bioprosthesis-subclinical-thrombosis-in-patients-undergoing-transcatheter-aortic-valve-replacement
#9
François Huchet, Vincent Letocart, Patrice Guerin, Caroline Cueff, Julie Roy-Giocosa, Béatrice Guyomarch-Delasalle, Philippe Jaafar, Thibaut Manigold
BACKGROUND: Despite a lack of clear evidence, current European guidelines recommend antiplatelet therapy after transcatheter aortic valve replacement (TAVR). Recent investigations suggest that bioprosthesis thrombosis after TAVR is not uncommon and may be prevented by anticoagulation, but not by antiplatelet therapy. AIMS: The study objective was to assess the impact of the antithrombotic regimen on post-TAVR early haemodynamics. METHODS: Patients eligible for TAVR with an Edwards SAPIEN 3 valve were included in this prospective observational study...
September 21, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28916673/radiographic-and-clinical-brain-infarcts-in-cardiac-and-diagnostic-procedures-a-systematic-review-and-meta-analysis
#10
REVIEW
Sung-Min Cho, Abhishek Deshpande, Vinay Pasupuleti, Adrian V Hernandez, Ken Uchino
BACKGROUND AND PURPOSE: The incidence of periprocedural brain infarcts varies among cardiovascular procedures. In a systematic review, we compared the ratio of radiographic brain infarcts (RBI) to strokes and transient ischemic attacks across cardiac and vascular procedures. METHODS: We searched MEDLINE and 5 other databases for brain infarcts in aortic valve replacement, coronary artery bypass grafting, cardiac catheterization, and cerebral angiogram through September 2015...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28903993/mitral-regurgitation-in-patients-with-severe-aortic-stenosis-diagnosis-and-management
#11
REVIEW
Anna Sannino, Paul A Grayburn
Severe aortic stenosis (AS) and mitral regurgitation (MR) frequently coexist. Although some observational studies have reported that moderate or severe MR is associated with higher mortality, the optimal management of such patients is still unclear. Simultaneous replacement of both aortic and mitral valves is linked to significantly higher morbidity and mortality. Recent advances in minimally invasive surgical or transcatheter therapies for MR allow for staged procedures in which surgical or transcatheter aortic valve replacement (SAVR/TAVR) is done first and MR severity re-evaluated afterwards...
September 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28895996/transcatheter-aortic-valve-implantation-expert-consensus-of-the-association-of-cardiovascular-interventions-of-the-polish-cardiac-society-and-the-polish-society-of-cardio-thoracic-surgeons-approved-by-the-board-of-the-polish-cardiac-society%C3%A2
#12
Radosław Parma, Michał O Zembala, Maciej Dąbrowski, Dariusz Jagielak, Adam Witkowski, Piotr Suwalski, Dariusz Dudek, Piotr Olszówka, Wojciech Wojakowski, Roman Przybylski, Robert Gil, Mariusz Kuśmierczyk, Maciej Lesiak, Jerzy Sadowski, Sławomir Dobrzycki, Andrzej Ochała, Piotr Hoffman, Bogusław Kapelak, Jarosław Kaźmierczak, Marek Jasiński, Janina Stępińska, Piotr Szymański, Tomasz Hryniewiecki, Janusz Kochman, Marek Grygier, Marian Zembala, Jacek Legutko, Jacek Różański
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28885378/radial-force-an-underestimated-parameter-in-oversizing-transcatheter-aortic-valve-replacement-prostheses-in-vitro-analysis-with-five-commercialized-valves
#13
Sandrine Egron, Buntaro Fujita, Lucía Gullón, Pott Désirée, Thomas Schmitz-Rode, Stephan Ensminger, Ulrich Steinseifer
The goal is to inform in depth on transcatheter aortic valve replacement (TAVR) prosthesis mechanical behavior, depending on frame type, design, and size, and how it crucially impacts the oversizing issue in clinical use, and ultimately the procedure outcome. Transcatheter aortic valve replacement is an established therapy for high-risk patients suffering from aortic stenosis, and the indication for TAVR is progressively expanding to intermediate-risk patients. Choosing the optimal oversizing degree is crucial to safely anchor the TAVR valve-which involves limiting the risks for embolism, aortic regurgitation, conductance disturbance, or annulus rupture-and to increase the valve prosthesis performance...
September 5, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28877303/association-of-guideline-adherence-for-serial-evaluations-with-survival-and-adverse-clinical-events-in-patients-with-asymptomatic-severe-aortic-stenosis
#14
Aisha Ahmed, Paul Sorajja, Ross F Garberich, R Saeid Farivar, Kevin M Harris, Mario Gössl
Importance: For patients with asymptomatic severe aortic stenosis and normal left ventricular function, current practice guidelines empirically recommend serial evaluations every 6 to 12 months. The benefit of this clinical monitoring is unknown. Objective: To determine the association of guideline adherence with clinical outcomes in patients with asymptomatic severe aortic stenosis. Design, Setting, and Participants: This retrospective cohort study involved 300 patients with asymptomatic severe aortic stenosis who were seen in the ambulatory Minneapolis Heart Institute at Abbott Northwestern Hospital...
October 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28828046/modern-use-of-echocardiography-in-transcatheter-aortic-valve-replacement-an-up-date
#15
Cristina Caldararu, Serban Balanescu
Echocardiography is the cornerstone in the diagnosis of any valvular heart disease. The accurate diagnosis of aortic stenosis, the left ventricle function and the other heart valves evaluation are currently done by ultrasound alone. Prosthetic valve choice and dimensions prior to implantation can be done solely by proper use of echocardiography. The emergence of new methods to cure aortic stenosis such as trans-catheter aortic valve replacement (TAVR) emphasized the diagnostic value of cardiac ultrasound. The usefulness of echocardiography in TAVR can be divided in the baseline assessment (common to patients treated by conventional surgery), intra-procedural guidance of valve deployment and post-procedural follow-up...
December 2016: Mædica
https://www.readbyqxmd.com/read/28827255/self-reported-health-status-treatment-decision-and-survival-in-asymptomatic-and-symptomatic-patients-with-aortic-stenosis-in-a-western-norway-population-undergoing-conservative-treatment-a-cross-sectional-study-with-18-months-follow-up
#16
Kjersti Oterhals, Rune Haaverstad, Jan Erik Nordrehaug, Geir Egil Eide, Tone M Norekvål
OBJECTIVES: To investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes. DESIGN: A cross-sectional survey with an 18-month follow-up. SETTING: One tertiary university hospital in Western Norway. PARTICIPANTS: In all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study...
August 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28814237/statins-in-aortic-stenosis
#17
Karl Norrington, Emmanuel Androulakis, Evangelos Oikonomou, Georgia Vogiatzi, Dimitris Tousoulis
Calcific aortic stenosis (AS) is the most common form of valvular heart disease in Europe and North America. It is a progressive disease with a prolonged period of asymptomatic latency which eventually leads to critical left ventricular outflow tract obstruction necessitating surgical replacement of the valve. Statins are lipid-lowering drugs with a robust evidence base demonstrating clinical benefit in atherosclerotic coronary artery disease. There has therefore been significant interest in the potential benefit of statins in AS...
August 15, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28792140/effect-of-patient-prosthesis-mismatch-in-aortic-position-on-late-onset-tricuspid-regurgitation-and-clinical-outcomes-after-double-valve-replacement
#18
Seung Hyun Lee, Young Nam Youn, Byung Chul Chang, Hyun Chel Joo, Sak Lee, Kyung Jong Yoo
PURPOSE: Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR. MATERIALS AND METHODS: Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvular annuloplasty or replacement)...
September 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28789610/management-of-refractory-bleeding-post-cardiopulmonary-bypass-in-an-acute-heparin-induced-thrombocytopenia-type-ii-renal-failure-patient-who-underwent-urgent-cardiac-surgery-with-bivalirudin-angiox-%C3%A2-anticoagulation
#19
Kimberly Hassen, Maria R Maccaroni, Haytham Sabry, Smitangshu Mukherjee, Shankari Serumadar, Inderpaul Birdi
Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28759513/importance-of-early-detection-and-cardiovascular-surgical-intervention-in-marfan-syndrome
#20
Rita DelloStritto, Steve Branham, Christina Chemmachel, Jayna Patel, Dayna Skolkin, Salima Gilani, Klever Uleanya
Marfan syndrome is an autosomal dominant connective tissue disorder that affects multiple systems, including the skeletal, ligamentous, oculofacial, pulmonary, abdominal, neurological, and cardiovascular systems. Cardiovascular complications, which involve the aorta and aortic valve, contribute most significantly to patient morbidity and mortality. A literature review was conducted on pathophysiology of the disease and recommendations for early diagnosis and treatment. Diagnosis largely relies on clinical features and a thorough history...
July 2017: Advanced Emergency Nursing Journal
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