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By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
Jeffrey J Popma, Thomas G Gleason, Steven J Yakubov, J Kevin Harrison, John K Forrest, Brijeshwar Maini, Carlos E Ruiz, Duane S Pinto, Marco Costa, Jon Resar, John Conte, Juan Crestanello, Yanping Chang, Jae K Oh, Michael J Reardon, David H Adams
BACKGROUND: Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known. METHODS AND RESULTS: We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV...
July 2016: Circulation. Cardiovascular Interventions
Yuhao Shi, Harindra C Wijeysundera, Stephen E Fremes, Andrew E Simor
We identified risk factors for infection following transcatheter aortic valve implantation (TAVI); infection occurred in 35 (13.8%) of 253 patients. Variables associated with infection included chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 1.1-1.4), postprocedural hemorrhage (OR, 1.2; 95% CI, 1.0-1.3), and procedure-related stroke (OR, 1.6; 95% CI, 1.3-2.1). Infect Control Hosp Epidemiol 2016;37:1094-1097.
September 2016: Infection Control and Hospital Epidemiology
Phillip M Freeman, Majd B Protty, Omar Aldalati, Arron Lacey, William King, Richard A Anderson, Dave Smith
OBJECTIVES: Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed with a TAVI implant. DESIGN: Retrospective cohort study from real-world data. SETTING: Electronic patient letters were searched for patients with a diagnosis of severe aortic stenosis and a formal outpatient STD prior to the availability of TAVI (1999-2009)...
2016: Open Heart
Stefan Toggweiler, Stefan Stortecky, Erik Holy, Katarzyna Zuk, Florim Cuculi, Fabian Nietlispach, Zaid Sabti, Raluca Suciu, Willibald Maier, Peiman Jamshidi, Francesco Maisano, Stephan Windecker, Richard Kobza, Peter Wenaweser, Thomas F Lüscher, Ronald K Binder
OBJECTIVES: The study sought to identify predictors for delayed high-degree atrioventricular block (AVB) in patients undergoing transcatheter aortic valve replacement (TAVR) and determine the need and required duration of telemetry monitoring. BACKGROUND: Little is known about predictors and timing of high-degree AVB. METHODS: A total of 1,064 patients (52% women) without a permanent pacemaker undergoing TAVR at 3 centers in Switzerland were investigated...
June 27, 2016: JACC. Cardiovascular Interventions
Sameer Arora, Jacob A Misenheimer, Wesley Jones, Amol Bahekar, Melissa Caughey, Cassandra J Ramm, Thomas G Caranasos, Michael Yeung, John P Vavalle
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons. METHODS: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients...
June 2016: Cardiovascular Diagnosis and Therapy
Giuseppe Gargiulo, Anna Sannino, Davide Capodanno, Marco Barbanti, Sergio Buccheri, Cinzia Perrino, Piera Capranzano, Ciro Indolfi, Bruno Trimarco, Corrado Tamburino, Giovanni Esposito
BACKGROUND: The comparative benefits and harms of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for patients with aortic stenosis are unclear. PURPOSE: To compare clinical outcomes, including early (≤30-day) and midterm (≤1-year) mortality, in adults with severe aortic stenosis undergoing either TAVI or SAVR. DATA SOURCES: MEDLINE, Cochrane, and Scopus databases (without language restrictions) from April 2002 to 5 April 2016; multiple registries and Web sites; scientific meeting presentations...
September 6, 2016: Annals of Internal Medicine
Ofer Havakuk, Maayan Konigstein, Eyal Ben Assa, Yaron Arbel, Yigal Abramowitz, Amir Halkin, Samuel Bazan, Haim Shmilovich, Gad Keren, Ariel Finkelstein, Shmuel Banai
BACKGROUND: Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI. METHODS AND RESULTS: From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10)...
October 2016: Cardiovascular Therapeutics
George L Hines, Vita Jaspan, Brian J Kelly, Rose Calixte
Background Transfemoral aortic valve replacement (TAVR) is a novel technique for treating aortic stenosis, yet vascular complications are yet to be delineated. Objectives This study aims to study the vascular complications of TAVR with Edwards Sapien valves (Edwards Lifesciences Corp., Irvine, CA). Methods We performed a retrospective evaluation of TAVR patients. Standard demographics, femoral vessel and sheath size, access type (femoral cut-down [FC], percutaneous access [PFA], and iliac conduit [IC]), and treatment method were recorded...
June 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Scott Somerville, Elizabeth Rosolowsky, Somjate Suntratonpipat, Rose Girgis, Benjamin H Goot, Edythe B Tham
OBJECTIVE: To compare the detection of cardiac lesions with the use of cardiac magnetic resonance imaging (CMR) and conventional echocardiography in children with Turner syndrome. STUDY DESIGN: Twenty-four girls with Turner syndrome, 8-18 years of age, were recruited through the Pediatric Endocrinology Program. Participants underwent CMR and echocardiography within a 2-year period, and discrepancies between the results of each modality were identified. RESULTS: Fifteen of 24 (63%) girls had a cardiac lesion identified on CMR or echocardiography...
August 2016: Journal of Pediatrics
Victor Dayan, Gustavo Vignolo, Gerardo Soca, Juan Jose Paganini, Daniel Brusich, Philippe Pibarot
OBJECTIVES: This study sought to evaluate predictors of prosthesis-patient mismatch (PPM) and its association with the risk of perioperative and overall mortality. BACKGROUND: PPM is associated with increased mid- and long-term mortality after surgical aortic valve replacement. Conflicting results have been reported with regard to its association with perioperative mortality. METHODS: Databases were searched for studies published between 1965 and 2014...
August 2016: JACC. Cardiovascular Imaging
Romain Didier, Edward Koifman, Sarkis Kiramijyan, Smita I Negi, Rebecca Torguson, Petros Okubagzi, Augusto D Pichard, Ron Waksman
AIMS: The present study aimed to evaluate the impact of prior cardiovascular events (CVE) on outcome in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Patients with severe AS undergoing TAVR between May 2007 and March 2015 were included and categorized to patients with and without prior stroke, defined as embolic, hemorrhagic stroke and transit ischemic attack. Baseline, procedural characteristics, in-hospital outcomes, and 1-month and 1-year mortality were compared in accordance with the Valve Academic Research Consortium-2 consensus...
July 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Solomon J Sager, Abdulla A Damluji, Joshua A Cohen, Sachil Shah, Brian P O'Neill, Carlos E Alfonso, Claudia A Martinez, Robert J Myerburg, Alan W Heldman, Mauricio G Cohen, Donald B Williams, Roger G Carrillo
BACKGROUND: Electrocardiographic conduction abnormalities following transcatheter aortic valve replacement (TAVR) with the Edwards-Sapien valve (ESV) are not uncommon and may be transient. We sought to examine the clinical time-course of conduction abnormalities after TAVR with ESV and determine risk factors for persistent abnormalities. METHODS: In this single-center prospective study, 116 consecutive patients underwent implantation of the ESV after approval by the Food and Drug Administration (FDA)...
May 28, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Seyed Hossein Aalaei-Andabili, Negiin Pourafshar, Anthony A Bavry, Charles T Klodell, R David Anderson, Ashkan Karimi, John W Petersen, Thomas M Beaver
BACKGROUND: Acute kidney injury (AKI) during transcatheter aortic valve replacement (TAVR) increases morbidity and mortality. In this study, we investigated the incidence and risk factors for AKI in patients undergoing TAVR. METHODS: Two hundred ninety consecutive patients underwent TAVR. Valve Academic Research Consortium (VARC)-I criteria for AKI diagnosis at 72 hours, and VARC-II criteria at seven days were employed. RESULTS: Overall AKI incidence was 24...
July 2016: Journal of Cardiac Surgery
Stuart J Head, Darren Mylotte, Michael J Mack, Nicolo Piazza, Nicolas M van Mieghem, Martin B Leon, A Pieter Kappetein, David R Holmes
In the United States, new surgical heart valves can be approved on the basis of objective performance criteria (OPC). In contrast, the US Food and Drug Administration traditionally requires stricter criteria for transcatheter heart valve (THV) approval, including randomized, clinical trials. Recent US Food and Drug Administration approval of new-generation THVs based on single-arm studies has generated interest in alternative study approaches for THV device approval. This review evaluates whether THV device approval could follow a pathway analogous to that of surgical heart valves by incorporating OPC and provides several considerations and recommendations...
May 24, 2016: Circulation
Colin M Barker
PURPOSE OF REVIEW: Clinical trials in transcatheter aortic valve replacement (TAVR) have been essential in establishing the effectiveness as well as the limitations of this exciting and disruptive technology. This review will focus on clinical trials related to TAVR that have been presented in the past year or are currently enrolling, as well as future trials that are in the planning stages. RECENT FINDINGS: The currently available devices have gone through iterations to improve safety and outcomes, including lower profiles to reduce bleeding complications as well as adding a sealing skirt or allowing for re-positioning in order to decrease para-valvular regurgitation and need for a permanent pacemaker...
July 2016: Current Opinion in Cardiology
Florence Leclercq, Anais Iemmi, Benoit Lattuca, Jean-Christophe Macia, Richard Gervasoni, Francois Roubille, Thomas Gandet, Laurent Schmutz, Mariama Akodad, Audrey Agullo, Marine Verges, Erika Nogue, Gregory Marin, Nicolas Nagot, Francois Rivalland, Nicolas Durrleman, Gabriel Robert, Delphine Delseny, Bernard Albat, Guillaume Cayla
Admission to the intensive care unit (ICU) is a standard of care after transcatheter aortic valve implantation (TAVI); however, the improvement of the procedure and the need to minimize the unnecessary use of medical resources call into question this strategy. We evaluated prospectively 177 consecutive patients who underwent TAVI. Low-risk patients, admitted to conventional cardiology units, had stable clinical state, transfemoral access, no right bundle branch block, permanent pacing with a self-expandable valve, and no complication occurring during the procedure...
July 1, 2016: American Journal of Cardiology
André Luiz Silveira Souza, Constantino González Salgado, Ricardo Mourilhe-Rocha, Evandro Tinoco Mesquita, Luciana Cristina Lima Correia Lima, Nelson Durval Ferreira Gomes de Mattos, Arnaldo Rabischoffsky, Francisco Eduardo Sampaio Fagundes, Alexandre Siciliano Colafranceschi, Luiz Antonio Ferreira Carvalho
BACKGROUND: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. OBJECTIVE: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. METHODS: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality...
June 2016: Arquivos Brasileiros de Cardiologia
Rajiv Tayal, Humayun Iftikhar, Benjamin LeSar, Rahul Patel, Naveen Tyagi, Marc Cohen, Najam Wasty
Objective. The use of the axillary artery as an access site has lost favor in percutaneous intervention due to the success of these procedures from a radial or brachial alternative. However, these distal access points are unable to safely accommodate anything larger than a 7-French sheath. To date no studies exist describing the size of the axillary artery in relation to the common femoral artery in a patient population. We hypothesized that the axillary artery is of comparable size to the CFA in most patients and less frequently diseased...
2016: International Journal of Vascular Medicine
Gidon Y Perlman, Philipp Blanke, Danny Dvir, Gregor Pache, Thomas Modine, Marco Barbanti, Erik W Holy, Hendrik Treede, Philipp Ruile, Franz-Josef Neumann, Caterina Gandolfo, Francesco Saia, Corrado Tamburino, George Mak, Christopher Thompson, David Wood, Jonathon Leipsic, John G Webb
OBJECTIVES: This study evaluated the results of transcatheter aortic valve replacement (TAVR) in bicuspid aortic stenosis (AS) using a new-generation TAVR device. BACKGROUND: A bicuspid AS is often considered a relative contraindication to TAVR. Although initial reports have demonstrated feasibility using early-generation devices, outcomes have not matched those seen with tricuspid AS. Paravalvular aortic regurgitation (AR) has been particularly problematic. METHODS: We collected baseline characteristics, procedural data, and 30-day clinical follow-up findings from 8 centers in Europe and Canada that had performed TAVR in bicuspid AS using the SAPIEN 3 valve...
April 25, 2016: JACC. Cardiovascular Interventions
Tomo Ando, Alexandros Briasoulis, Anthony A Holmes, Luis Afonso, Theodore Schreiber, Ashok Kondur
BACKGROUND: Patients with severe aortic stenosis (AS) and previous coronary artery bypass graft (CABG) surgery have increased risk for aortic valve replacement. Whether surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) offers better outcomes in this population is unclear. We aimed to assess outcomes of TAVR and SAVR in patients with previous CABG. METHODS: A systematic literature search of Medline, EMBASE and Cochrane library was conducted...
July 15, 2016: International Journal of Cardiology
2016-04-26 02:29:20
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