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https://www.readbyqxmd.com/read/28738447/comparison-of-local-versus-general-anesthesia-in-patients-undergoing-transcatheter-aortic-valve-replacement-a-meta-analysis
#1
Pedro A Villablanca, Divyanshu Mohananey, Katarina Nikolic, Sripal Bangalore, David P Slovut, Verghese Mathew, Vinod H Thourani, Josep Rode's-Cabau, Iván J Núñez-Gil, Tina Shah, Tanush Gupta, David F Briceno, Mario J Garcia, Jacob T Gutsche, John G Augoustides, Harish Ramakrishna
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA). However, there is increasing data supporting the safety of performing TAVR under local anesthesia/conscious sedation (LA). We performed a meta-analysis to gain better understanding of the safety and efficacy of LA versus GA in patients with severe aortic stenosis undergoing TAVR. METHODS AND RESULTS: We comprehensively searched EMBASE, PubMed, and Web of Science...
July 24, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28734909/prognostic-value-of-exercise-stress-echocardiography-in-asymptomatic-patients-with-aortic-valve-stenosis
#2
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/28729377/abundant-dystrophic-calcifications-mimicking-aortic-valve-abscess-in-a-patient-undergoing-elective-aortic-valve-replacement
#3
Adam L Booth, Christine Q Li, Ghannam Ayed Al-Dossari, Heather L Stevenson
Dystrophic calcifications of the aortic valve may cause symptomatic aortic stenosis and account for a significant portion of patients who undergo elective valve replacement. Calcifications appearing grossly as a cloudy fluid surrounding the aortic valve leaflets are an uncommon finding. Normally, calcified aortic valves are characterised by large, nodular masses within the aortic cusps. We report a case of dystrophic calcifications on a stenotic aortic valve encountered intraoperatively, which was suggestive of infective endocarditis and abscess formation...
July 19, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28728722/transcatheter-aortic-valve-replacement-a-review
#4
REVIEW
John H Braxton, Kelly S Rasmussen, Milind S Shah
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve...
August 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28728688/transcatheter-versus-surgical-aortic%C3%A2-valve%C3%A2-replacement-propensity-matched-comparison
#5
J Matthew Brennan, Laine Thomas, David J Cohen, David Shahian, Alice Wang, Michael J Mack, David R Holmes, Fred H Edwards, Naftali Z Frankel, Suzanne J Baron, John Carroll, Vinod Thourani, E Murat Tuzcu, Suzanne V Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L Graham, Dadi Dai, Fan Li, Roland A Matsouaka, Sean O'Brien, Fan Li, Michael J Pencina, Eric D Peterson
BACKGROUND: Randomized trials support the use of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in high- and intermediate-risk patients, but the generalizability of those results in clinical practice has been challenged. OBJECTIVES: The aim of this study was to determine the safety and effectiveness of TAVR versus surgical aortic valve replacement (SAVR), particularly in intermediate- and high-risk patients, in a nationally representative real-world cohort...
July 25, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28728657/frequency-timing-and-impact-of-access-site-and-non-access-site-bleeding%C3%A2-on-mortality-among-patients%C3%A2-undergoing-transcatheter-aortic%C3%A2-valve%C3%A2-replacement
#6
Raffaele Piccolo, Thomas Pilgrim, Anna Franzone, Marco Valgimigli, Alan Haynes, Masahiko Asami, Jonas Lanz, Lorenz Räber, Fabien Praz, Bettina Langhammer, Eva Roost, Stephan Windecker, Stefan Stortecky
OBJECTIVES: The aim of this study was to examine the frequency, timing, and association of access-site and non-access-site bleeding with mortality in the setting of transcatheter aortic valve replacement (TAVR) during long-term follow-up. BACKGROUND: Bleeding is frequent and associated with impaired prognosis in patients undergoing TAVR. It is currently unknown whether the site of bleeding differentially influences the outcomes of TAVR patients. METHODS: In total, 926 consecutive patients undergoing TAVR from 2007 through 2014 were evaluated...
July 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28728656/the-prognostic-effects-of-coronary-disease-severity-and-completeness-of-revascularization-on-mortality-in-patients-undergoing-transcatheter-aortic-valve-replacement
#7
Guy Witberg, Ehud Regev, Shmuel Chen, Abbid Assali, Israel M Barbash, David Planer, Hana Vaknin-Assa, Victor Guetta, Vojislav Vukasinovic, Katia Orvin, Haim D Danenberg, Amit Segev, Ran Kornowski
OBJECTIVES: The study sought to examine the effect of coronary artery disease (CAD) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: CAD is common in the TAVR population. However, there are conflicting data on the prognostic significance of CAD and its treatment in this population. METHODS: The authors analyzed 1,270 consecutive patients with severe aortic stenosis (AS) undergoing TAVR at 3 Israeli centers...
July 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28726430/-thoughts-about-valvular-abnormalities-yesterday-and-today
#8
Pavel Gregor, Hana Línková
The article deals with the problems of acquired valvular disorders. It mainly focuses on the new findings regarding ethiopathogenesis, diagnostics, evaluation and treatment, especially catheterization. In advanced countries, post-rheumatic abnormalities have almost disappeared, their current etiology has substantially changed (mitral stenosis). The earlier relatively rare degenerative changes now predominate, mainly affecting older patients (aortic stenosis). Also the treatment methods for acquired abnormalities have substantially changed - currently catheterization approaches are used more frequently in their correction...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28714932/thrombospondins-a-role-in-cardiovascular-disease
#9
REVIEW
Dimitry A Chistiakov, Alexandra A Melnichenko, Veronika A Myasoedova, Andrey V Grechko, Alexander N Orekhov
Thrombospondins (TSPs) represent extracellular matrix (ECM) proteins belonging to the TSP family that comprises five members. All TSPs have a complex multidomain structure that permits the interaction with various partners including other ECM proteins, cytokines, receptors, growth factors, etc. Among TSPs, TSP1, TSP2, and TSP4 are the most studied and functionally tested. TSP1 possesses anti-angiogenic activity and is able to activate transforming growth factor (TGF)-β, a potent profibrotic and anti-inflammatory factor...
July 17, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28712585/conduction-disturbance-after-isolated-surgical-aortic-valve-replacement-in-degenerative-aortic-stenosis
#10
You Mi Hwang, Jun Kim, Ji Hyun Lee, Minsu Kim, Jongmin Hwang, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Gi Byoung Nam, Kee Joon Choi, Cheol Hyun Chung, Jae Won Lee, You Ho Kim
OBJECTIVE: Conduction disturbances are common in patients with aortic stenosis. We investigated the incidence, reversibility, and prognosis of conduction disorders requiring permanent pacemaker implantation in patients with degenerative aortic stenosis after isolated aortic valve replacement. METHODS: This was a retrospective study conducted at a tertiary care center. We evaluated the incidence of conduction disturbances in patients who underwent isolated surgical aortic valve replacement for aortic stenosis between January 2005 and May 2015...
June 15, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28712069/left-atrial-dysfunction-as-a-determinant-of-pulmonary-hypertension-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction
#11
Andreea Calin, Anca D Mateescu, Monica Rosca, Carmen C Beladan, Roxana Enache, Simona Botezatu, Iulian Cosei, Cosmin Calin, Marian Simion, Carmen Ginghina, Andreea C Popescu, Bogdan A Popescu
In patients with severe aortic stenosis (AS), the presence of pulmonary hypertension (PH) has been linked to a poor prognosis. We aimed to assess the main determinants of PH in patients with severe AS and preserved left ventricular ejection fraction (LVEF). We prospectively enrolled 108 consecutive patients with isolated severe AS (indexed aortic valve area <0.6 cm(2)/m(2)) and LVEF >50%, in sinus rhythm. Left atrial (LA) function was assessed using longitudinal deformation parameters (by speckle tracking echocardiography)...
July 15, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28710182/elevation-of-b-type-natriuretic-peptide-at-discharge-is-associated-with-2-year-mortality-after-transcatheter-aortic-valve-replacement-in-patients-with-severe-aortic-stenosis-insights-from-a-multicenter-prospective-ocean-tavi-optimized-transcatheter-valvular
#12
Kazuki Mizutani, Masahiko Hara, Shinichi Iwata, Takashi Murakami, Toshihiko Shibata, Minoru Yoshiyama, Toru Naganuma, Futoshi Yamanaka, Akihiro Higashimori, Norio Tada, Kensuke Takagi, Motoharu Araki, Hiroshi Ueno, Minoru Tabata, Shinichi Shirai, Yusuke Watanabe, Masanori Yamamoto, Kentaro Hayashida
BACKGROUND: In this study, we sought to investigate the 2-year prognostic impact of B-type natriuretic peptide (BNP) levels at discharge, following transcatheter aortic valve replacement. METHODS AND RESULTS: We enrolled 1094 consecutive patients who underwent transcatheter aortic valve replacement between 2013 and 2016. Study patients were stratified into 2 groups according to survival classification and regression tree analysis (high versus low BNP groups). We evaluated the impact of high BNP on 2-year mortality compared with that of low BNP using a multivariable Cox model, and assessed whether this stratification would improve predictive accuracy for determining 2-year mortality by assessing time-dependent net reclassification improvement and integrated discrimination improvement...
July 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28710181/severe-aortic-stenosis-in-dialysis-patients
#13
Yuichi Kawase, Tomohiko Taniguchi, Takeshi Morimoto, Kazushige Kadota, Keiichiro Iwasaki, Akimune Kuwayama, Masanobu Ohya, Takenobu Shimada, Hidewo Amano, Takeshi Maruo, Yasushi Fuku, Chisato Izumi, Takeshi Kitai, Naritatsu Saito, Eri Minamino-Muta, Takao Kato, Tsukasa Inada, Moriaki Inoko, Katsuhisa Ishii, Tatsuhiko Komiya, Michiya Hanyu, Kenji Minatoya, Takeshi Kimura
BACKGROUND: Characteristics and prognosis of hemodialysis patients with severe aortic stenosis have not yet been well defined. METHODS AND RESULTS: The CURRENT AS (contemporary outcomes after surgery and medical treatment in patients with severe aortic stenosis) registry, a Japanese multicenter registry, enrolled 3815 consecutive patients with severe aortic stenosis. There were 405 hemodialysis patients (initial aortic valve replacement [AVR] group: N=135 [33.3%], and conservative group: N=270) and 3410 nonhemodialysis patients (initial AVR group: N=1062 [31...
July 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28709382/severe-aortic-valve-stenosis-due-to-alkaptonuric-ochronosis
#14
Magdy El-Sayed Ahmed, Omar Hussain, David A Ott, Muhammad Aftab
Alkaptonuric ochronosis is a rare cause of aortic valve stenosis. We report the case of a 61-year-old female patient with alkaptonuria who presented to our institute with the clinical picture of severe aortic valve stenosis, which was confirmed by transthoracic echocardiography. On aortotomy, she was noted to have an impressive black discoloration of ascending aorta and the aortic root complex involving the aortic valve leaflets. She underwent an uneventful aortic valve replacement. She was discharged home 10 days postoperatively...
July 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28707021/the-response-to-trendelenburg-position-is-minimally-affected-by-underlying-hemodynamic-conditions-in-patients-with-aortic-stenosis
#15
Abraham Sonny, Daniel I Sessler, Jing You, Babak Kateby Kashy, Sheryar Sarwar, Akhil K Singh, Shiva Sale, Andrej Alfirevic, Andra E Duncan
PURPOSE: Trendelenburg positioning is commonly used to temporarily treat intraoperative hypotension. The Trendelenburg position improves cardiac output in normovolemic or anesthetized patients, but not hypovolemic or non-anesthetized patients. Therefore, the response to Trendelenburg positioning may vary depending on patient population or hemodynamic conditions. We thus tested the hypothesis that the effectiveness of the Trendelenburg position, as indicated by an increase in cardiac output, improves after replacement of a stenotic aortic valve...
July 13, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28706584/assessment-of-aortic-valve-disease-a-clinician-oriented-review
#16
REVIEW
Andrei D Mǎrgulescu
Aortic valve disease [aortic stenosis (AS) and aortic regurgitation (AR)] represents an important global health problem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery (either replacement or - in selected cases - aortic valve repair) remains the gold standard of care. To properly identify those patients who are candidates for surgery, the clinician has to carefully assess the severity of valve disease with an understanding of the potential pitfalls involved in these assessments...
June 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28705379/prognostic-usefulness-of-cardiopulmonary-exercise-testing-for-managing-patients-with-severe-aortic-stenosis
#17
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/28702876/cardiovascular-histopathology-of-a-11-year-old-with-mucopolysaccharidosis-vii-demonstrates-fibrosis-macrophage-infiltration-and-arterial-luminal-stenosis
#18
Valerie Lew, Louis Pena, Robert Edwards, Raymond Y Wang
Mucopolysaccharidosis type VII (MPS VII) is caused by β-glucuronidase deficiency, resulting in lysosomal accumulation of glycosaminoglycans (GAGs) and multisystemic disease. We present cardiovascular gross and histopathology findings from a 11-year-old MPS VII male, who expired after developing ventricular fibrillation following anesthesia induction. Gross anatomic observations were made at autopsy; postmortem formalin-fixed paraffin-embedded samples of the carotid artery, aorta, myocardium, and valves were sectioned and stained with hematoxylin-eosin, Verhoeff-Van Gieson, CD68, and trichrome stains...
July 13, 2017: JIMD Reports
https://www.readbyqxmd.com/read/28701592/risk-factors-of-postcardiotomy-ventricular-dysfunction-in-moderate-to-high-risk-patients-undergoing-open-heart-surgery
#19
Christoph Ellenberger, Tornike Sologashvili, Mustafa Cikirikcioglu, Gabriel Verdon, John Diaper, Tiziano Cassina, Marc Licker
INTRODUCTION: Ventricular dysfunction requiring inotropic support frequently occurs after cardiac surgery, and the associated low cardiac output syndrome largely contributes to postoperative death. We aimed to study the incidence and potential risk factors of postcardiotomy ventricular dysfunction (PCVD) in moderate-to-high risk patients scheduled for open-heart surgery. METHODS: Over a 5-year period, we prospectively enrolled 295 consecutive patients undergoing valve replacement for severe aortic stenosis or coronary artery bypass surgery who presented with Bernstein-Parsonnet scores >7...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28701528/blood-pressure-and-arterial-load-after-transcatheter-aortic-valve-replacement-for-aortic-stenosis
#20
MULTICENTER STUDY
Brian R Lindman, Catherine M Otto, Pamela S Douglas, Rebecca T Hahn, Sammy Elmariah, Neil J Weissman, William J Stewart, Girma M Ayele, Feifan Zhang, Alan Zajarias, Hersh S Maniar, Hasan Jilaihawi, Eugene Blackstone, Khaja M Chinnakondepalli, E Murat Tuzcu, Martin B Leon, Philippe Pibarot
BACKGROUND: After aortic valve replacement, left ventricular afterload is often characterized by the residual valve obstruction. Our objective was to determine whether higher systemic arterial afterload-as reflected in blood pressure, pulsatile and resistive load-is associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Total, pulsatile, and resistive arterial load were measured in 2141 patients with severe aortic stenosis treated with TAVR in the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had systolic blood pressure (SBP) and an echocardiogram obtained 30 days after TAVR...
July 2017: Circulation. Cardiovascular Imaging
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