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Recommendations for aortic valve replacement

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https://www.readbyqxmd.com/read/28814237/statins-in-aortic-stenosis
#1
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
#2
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
#3
Kimberly Hassen, Maria R Maccaroni, Haytham Sabry, Smitangshu Mukherjee, Shankari Serumadar, Inderpaul Birdi
Acute heparin-induced thrombocytopenia (HIT) patients present myriad 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
#4
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
https://www.readbyqxmd.com/read/28756075/-tavi-history-and-perspectives
#5
Anastasia Sokoloff, Hélène Eltchaninoff
Nearly 20 years have passed from the concept to clinical development of percutaneous aortic valve replacement, starting from an idea considered "stupid" of Professor Alain Cribier in Rouen. After a first phase of compassionate implantation, large randomized trials PARTNER and COREVALVE US have allowed TAVI to impose itself in the European and American recommendations in patients inoperable or considered with high surgical risk. Next European recommendations on the management of valvular heart diseases expected in 2017 should take into account the positive results observed in intermediate risk patients in the PARTNER 2 and SURTAVI studies, recently adopted in the US recommendations...
July 26, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28734909/prognostic-value-of-exercise-stress-echocardiography-in-asymptomatic-patients-with-aortic-valve-stenosis
#6
Coppelia Goublaire, Maria Melissopoulou, David Lobo, Naozumi Kubota, Constance Verdonk, Claire Cimadevilla, Isabelle Codogno, Eric Brochet, Alec Vahanian, David Messika-Zeitoun
OBJECTIVES: This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS). BACKGROUND: Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated...
July 13, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28734885/clinical-impact-of-baseline-right-bundle-branch-block-in-patients-undergoing-transcatheter-aortic-valve-replacement
#7
Vincent Auffret, John G Webb, Hélène Eltchaninoff, Antonio J Muñoz-García, Dominique Himbert, Corrado Tamburino, Luis Nombela-Franco, Fabian Nietlispach, César Morís, Marc Ruel, Antonio E Dager, Vicenç Serra, Asim N Cheema, Ignacio J Amat-Santos, Fábio Sandoli de Brito, Pedro Alves Lemos, Alexandre Abizaid, Rogério Sarmento-Leite, Eric Dumont, Marco Barbanti, Eric Durand, Juan H Alonso Briales, Alec Vahanian, Claire Bouleti, Sebastiano Immè, Francesco Maisano, Raquel Del Valle, Luis Miguel Benitez, Bruno García Del Blanco, Rishi Puri, François Philippon, Marina Urena, Josep Rodés-Cabau
OBJECTIVES: This study sought to assess the influence of baseline right bundle branch block (RBBB) on all-cause and cardiovascular mortality as well as sudden cardiac death (SCD) among patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Few data exist regarding the late clinical impact of pre-existing RBBB in TAVR recipients. METHODS: A total of 3,527 patients (mean age 82 ± 8 years, 50.1% men) were evaluated according to the presence of RBBB on baseline electrocardiography...
July 13, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28734880/dual-versus-single-antiplatelet-regimen-with-or-without-anticoagulation-in-transcatheter-aortic-valve-replacement-indirect-comparison-and-meta-analysis
#8
Monica Verdoia, Lucia Barbieri, Matteo Nardin, Harry Suryapranata, Giuseppe De Luca
INTRODUCTION AND OBJECTIVES: There is uncertainty on the correct management of antithrombotic therapies after transcatheter aortic valve replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently recommended on an empirical basis. The aim of the present meta-analysis was to assess the safety and effectiveness of DAPT in patients undergoing TAVR. METHODS: Studies comparing different antithrombotic regimens after TAVR were included. The primary endpoint was 30-day overall mortality...
July 19, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28705379/prognostic-usefulness-of-cardiopulmonary-exercise-testing-for-managing-patients-with-severe-aortic-stenosis
#9
Van D Le, Gunnar V Jensen, Lars Kjøller-Hansen
The approach to managing asymptomatic or questionably symptomatic patients for aortic stenosis is difficult. We aimed to determine whether cardiopulmonary exercise testing (CPET) is prognostically useful in such patients. Patients judged asymptomatic or questionably symptomatic for aortic stenosis with aortic valve area index <0.6 cm(2)/m(2) and left ventricular ejection fraction ≥0.50 were managed conservatively provided they had either (group 1) normal peak oxygen consumption and peak oxygen pulse (>83% and >95% of the predicted values, respectively) or (group 2) subnormal peak oxygen consumption or peak oxygen pulse but with CPET data pointing to pathologies other than hemodynamic compromise from aortic stenosis...
June 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28693934/frailty-in-older-adults-undergoing-aortic%C3%A2-valve-replacement-the-frailty-avr-study
#10
Jonathan Afilalo, Sandra Lauck, Dae H Kim, Thierry Lefèvre, Nicolo Piazza, Kevin Lachapelle, Giuseppe Martucci, Andre Lamy, Marino Labinaz, Mark D Peterson, Rakesh C Arora, Nicolas Noiseux, Andrew Rassi, Igor F Palacios, Philippe Généreux, Brian R Lindman, Anita W Asgar, Caroline A Kim, Amanda Trnkus, José A Morais, Yves Langlois, Lawrence G Rudski, Jean-Francois Morin, Jeffrey J Popma, John G Webb, Louis P Perrault
BACKGROUND: Frailty is a geriatric syndrome that diminishes the potential for functional recovery after a transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its integration in clinical practice has been limited by a lack of consensus on how to measure it. OBJECTIVES: This study sought to compare the incremental predictive value of 7 different frailty scales to predict poor outcomes following TAVR or SAVR...
July 1, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28671806/valvular-heart-disease-in-adults-management-of-prosthetic-heart-valves
#11
John F Trujillo, Steven M Hollenberg
Patients undergoing cardiac valve replacement may receive mechanical or bioprosthetic valves. Mechanical valves require lifelong anticoagulation but are durable and the need for a second surgery is up to eightfold times less than with bioprosthetic valves. Bioprosthetic valves do not require lifelong anticoagulation and thus are associated with fewer bleeding complications but they are less durable and associated with higher morbidity and mortality rates, particularly in younger patients. Anticoagulation with mechanical valves is achieved using warfarin; use of direct-acting oral anticoagulants is not indicated...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28669505/bioprosthetic-valve-fracture-to-facilitate-transcatheter-valve-in-valve-implantation
#12
Keith B Allen, Adnan K Chhatriwalla, David J Cohen, John T Saxon, Sanjeev Aggarwal, Anthony Hart, Suzanne Baron, J Russell Davis, Alex F Pak, Danny Dvir, A Michael Borkon
BACKGROUND: Valve-in-valve transcatheter aortic valve replacement is less effective in small surgical bioprostheses. We evaluated the feasibility of bioprosthetic valve fracture with a high-pressure balloon to facilitate valve-in-valve transcatheter aortic valve replacement. METHODS: In vitro bench testing on aortic tissue valves was performed on 19-mm and 21-mm Mitroflow (Sorin, Milan, Italy), Magna and Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta and Biocor Epic (St...
June 29, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28616345/wrapping-of-the-ascending-aorta-revisited-is-there-any-role-left-for-conservative-treatment-of-ascending-aortic-aneurysm
#13
REVIEW
José María González-Santos, María Elena Arnáiz-García
Dilatation of the ascending aorta (AA) is a common finding in patients with aortic valve disease. The clinical practice guidelines recommend replacing the AA whenever the diameter exceeds 45 mm. However, no consensus has been reached regarding the approach when the aorta is only moderately dilated. Although the risk in aorta replacement is generally low, it may be higher when associated with other complex surgical procedures or it is carried out in elderly patients or patients with significant comorbidity. This would justify the use of alternative surgical techniques, which reduce surgical risk and guarantee a durable correction of the aortic pathology...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28593422/treatment-of-asymptomatic-aortic-valve-stenosis-watchful-waiting-or-early-intervention
#14
J Ledwoch, H Thiele
There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for the majority of asymptomatic patients. However, data on the prognosis of asymptomatic AS are inconsistent. Some reports claim an increased risk of complications and even mortality in this subset of patients when treated conservatively. Several factors are considered to contribute to the impaired outcome of asymptomatic patients, such as progressive myocardial damage or sudden cardiac death, during the watchful waiting period...
June 7, 2017: Herz
https://www.readbyqxmd.com/read/28536830/transcatheter-aortic-valve-implantation-in-patients-on-corticosteroid-therapy
#15
Ryosuke Higuchi, Tetsuya Tobaru, Kenichi Hagiya, Mike Saji, Keitaro Mahara, Itaru Takamisawa, Jun Shimizu, Shuichiro Takanashi, Morimasa Takayama
Transcatheter aortic valve implantation (TAVI) is recommended for patients who are inoperable or at high risk for surgical aortic valve replacement (SAVR). Corticosteroid therapy is considered to be a risk factor for SAVR, but there is a paucity of information about TAVI in patients taking corticosteroids. The aim of this study is to elucidate the outcome of TAVI in patients on chronic corticosteroid therapy, compared with SAVR. We retrospectively analyzed patients on corticosteroid therapy who underwent TAVI (n = 21) or SAVR (n = 30) for severe aortic stenosis in Sakakibara Heart Institute...
May 23, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28507251/stress-testing-in-asymptomatic-aortic-stenosis
#16
REVIEW
Björn Redfors, Philippe Pibarot, Linda D Gillam, Daniel Burkhoff, Jeroen J Bax, Brian R Lindman, Robert O Bonow, Patrick T O'Gara, Martin B Leon, Philippe Généreux
Aortic stenosis is 1 of the most common heart valve diseases among adults. When symptoms develop, prognosis is poor, and current guidelines recommend prompt aortic valve replacement. Depending of the severity of the aortic stenosis and the presence of concomitant heart disease and medical comorbidities, stress testing represents a reasonable strategy to help better risk stratify asymptomatic patients. The present report provides a comprehensive review of the current available data on stress testing in aortic stenosis and subsequently summarizes its potential for guiding the optimal timing of aortic valve replacement...
May 16, 2017: Circulation
https://www.readbyqxmd.com/read/28495211/maximum-aortic-valve-opening-phase-for-annulus-sizing-in-pre-tavr-cta
#17
Nam Ju Lee, Saurabh Jha, Bong Ju Lee, Harold Litt
RATIONALE AND OBJECTIVES: The optimal phase for the measurement of the aortic annular area for transcatheter aortic valve replacement (TAVR) is not standardized, although most agree that systolic measurements are preferred, when the annulus is larger. We hypothesized that the maximum annular area occurs at the cardiac phase of the maximum aortic valve opening (MAVO) and that this phase can be accurately and reproducibly assessed by visual inspection only. MATERIALS AND METHODS: The aortic valve opening area was inspected visually by two readers to determine the MAVO phase...
May 8, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28453794/blood-flow-competition-after-aortic-valve-bypass-an-evaluation-using-computational-fluid-dynamics
#18
Koji Kawahito, Naoyuki Kimura, Kenji Komiya, Masanori Nakamura, Yoshio Misawa
OBJECTIVES: Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD)...
May 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28444168/mechanical-versus-bioprosthetic-aortic-valve-replacement
#19
Stuart J Head, Mevlüt Çelik, A Pieter Kappetein
Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups...
April 20, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28434640/imaging-guidance-for-transcatheter-aortic-valve-replacement-is-transoesophageal-echocardiography-the-gold-standard
#20
REVIEW
Bo Xu, Philip M Mottram, Siobhan Lockwood, Ian T Meredith
Transcatheter aortic valve replacement (TAVR) is traditionally performed under cardiac imaging guidance. In the early TAVR experience, intra-procedural transoesophageal echocardiography (TOE) is recommended to guide device deployment, in the context of general anaesthesia (GA). Intra-procedural TOE imaging is particularly useful during TAVR deployment as a contrast-saving strategy for patients with renal impairment. Evidence has emerged recently demonstrating that in selected patients, transthoracic echocardiography (TTE) can be used to provide intra-procedural guidance for TAVR...
March 27, 2017: Heart, Lung & Circulation
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