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By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
Lionel Tastet, Louis Simard, Marie-Annick Clavel
The clinical management of asymptomatic patients with severe aortic valve stenosis (AS) may be challenging. Indeed, there is substantial controversy over the optimal timing of intervention for these patients, as some advocate early intervention while others urge for a conservative management until symptom onset. In the meantime of randomized clinical trials aiming to compare both strategies of management, an integrative approach including several imaging modalities as well as biomarkers of the myocardial damage may help to improve the risk stratification of patients with asymptomatic severe AS and individualize strategy of treatment...
May 2017: Current Treatment Options in Cardiovascular Medicine
Helmut Baumgartner, Judy Hung, Javier Bermejo, John B Chambers, Thor Edvardsen, Steven Goldstein, Patrizio Lancellotti, Melissa LeFevre, Fletcher Miller, Catherine M Otto
Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. Because clinical decision-making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. In the meantime, numerous new studies on aortic stenosis have been published with particular new insights into the difficult subgroup of low gradient aortic stenosis making an update of recommendations necessary...
March 1, 2017: European Heart Journal Cardiovascular Imaging
Thomas F Lüscher
No abstract text is available yet for this article.
March 1, 2017: European Heart Journal
Calogera Pisano, Pasquale Totaro, Oreste Fabio Triolo, Vincenzo Argano
OBJECTIVE: The aim of our study was to investigate potential clinical advantages of minimal access versus conventional surgical approach in older and severely obese patients undergoing isolated aortic valve replacement (AVR). METHODS: One hundred thirty-five patients undergoing isolated primary AVR were enrolled. Propensity score matching was used to compare 42 selected patients operated on ministernotomy (MS, group B) with 42 selected patients operated on full sternotomy (FS, group A)...
March 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Jonathan Afilalo
No abstract text is available yet for this article.
May 23, 2017: Circulation
Kishore J Harjai, Cindy L Grines, Jean-Michael Paradis, Susheel Kodali
Transcatheter aortic valve replacement (TAVR) continued to make major strides in 2016, simultaneously expanding its application to lower risk patients as well as more technically challenging subsets of patients with aortic stenosis (AS). The two major accomplishments this year were the establishment of TAVR as the preferred treatment strategy over surgical aortic valve replacement (SAVR) in intermediate risk patients, and initial signals that TAVR and SAVR may be clinically equivalent in low-risk populations...
April 2017: Journal of Interventional Cardiology
Elena V Dolmatova, Kasra Moazzami, James Maher, Marc Klapholz, Justin Sambol, Alfonso H Waller
OBJECTIVES: To describe national trends in the incidence and outcomes of patients with chordae tendineae rupture (CTR). METHODS: Patients who were diagnosed with CTR between 2000 and 2012 were identified in National (Nationwide) Inpatient Sample (NIS) registry. CTR was defined using validated International Classification of Diseases, 9th Edition, Clinical Modification diagnosis (ICD9-CM) codes. Results: A total of 37,287 (14,833 mitral valve repair, 7780 mitral valve replacement) CTR cases were identified...
February 27, 2017: Heart Surgery Forum
Shinichi Shirai, Tomohiko Taniguchi, Takeshi Morimoto, Kenji Ando, Kengo Korai, Kenji Minakata, Michiya Hanyu, Fumio Yamazaki, Tadaaki Koyama, Tatsuhiko Komiya, Norio Kanamori, Koichiro Murata, Takeshi Kitai, Yuichi Kawase, Chisato Izumi, Tsukasa Inada, Eri Minamino-Muta, Takao Kato, Moriaki Inoko, Katsuhisa Ishii, Naritatsu Saito, Kazuo Yamanaka, Noboru Nishiwaki, Hiroyuki Nakajima, Toshihiko Saga, Shogo Nakayama, Genichi Sakaguchi, Atsushi Iwakura, Kotaro Shiraga, Koji Ueyama, Keiichi Fujiwara, Senri Miwa, Junichiro Nishizawa, Mitsuru Kitano, Hitoshi Kitayama, Ryuzo Sakata, Takeshi Kimura
BACKGROUND: There is discordance regarding the effect of symptom status before aortic valve replacement (AVR) on long-term outcome after AVR in severe aortic stenosis (AS).Methods and Results:The CURRENT AS registry is a multicenter retrospective registry enrolling 3,815 consecutive patients with severe AS. Among 1,196 patients managed with the initial AVR strategy, long-term clinical outcomes were compared between the symptomatic patients (n=905), and asymptomatic patients (n=291)...
March 24, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
Elena Berti, Daniela Fortuna, Simona Bartoli, Cristina Ciuca, Anna Orlando, Salvatore Scondotto, Nera Agabiti, Stefano Salizzoni, Tiziana Claudia Aranzulla, Caterina Gandolfo, Rossana De Palma, Francesco Saia
BACKGROUND: The aim of this study was to estimate the cost of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) procedures, together with the cost of the first-year hospitalizations following the index ones, in 4 Italian regions where diffusion level of TAVI and coverage decisions are different. METHODS: The cost analysis was performed evaluating 372 patients enrolled consecutively from December 1, 2012 to September 30, 2015...
December 2016: Giornale Italiano di Cardiologia
Birgid Gonska, Julia Seeger, Justus Baarts, Christoph Rodewald, Dominik Scharnbeck, Wolfgang Rottbauer, Jochen Wöhrle
BACKGROUND: Residual paravalvular moderate or severe aortic regurgitation (AR) has been an independent risk factor for mortality after transcatheter aortic valve implantation (TAVI). The design of the third generation Edwards Sapien 3 (ES3; Edwards Lifesciences, Irvine, CA, USA) valve was optimized with an outer skirt to address the issue of paravalvular AR. METHODS AND RESULTS: We compared 100 consecutive patients treated with the ES3 for severe aortic stenosis with 100 patients treated with the Medtronic CoreValve (CV; Medtronic, Minneapolis, MN, USA) (Clinical Trial Registration: NCT02162069)...
June 2017: Journal of Cardiology
Luciana Thiago, Selma Rumiko Tsuji, Jonathan Nyong, Maria Es Puga, Aecio Ft Gois, Cristiane R Macedo, Orsine Valente, Álvaro N Atallah
BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus...
September 5, 2016: Cochrane Database of Systematic Reviews
Nuray Kahraman Ay, Yasin Ay, Osman Sönmez, Mehmet Akif Vatankulu, Ömer Göktekin
BACKGROUND: Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the quality of life (QoL) on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. METHODS: This prospective cohort study included 136 elderly patients (70 to 89 years of age), who underwent transfemoral TAVR due to degenerative aortic stenosis...
July 2016: Journal of Geriatric Cardiology: JGC
Daniel Grinberg, Matteo Pozzi, Fadi Farhat, Jean-François Obadia
The initial aorta (aortic valve, ring, sinuses and ascending aorta) constitutes an inseparable anatomical-functional entity. The "normal" diameter grows with age and body surface area. Two potential risks: aortic regurgitation (chronic complication) and aortic dissection (acute complication) The aortic diameter is the main factor of aortic dissection. Issues of the recommendations: set thresholds to indicate prophylactic surgery (avoid complication) Betablockers are indicated, especially in cases of hypertension or proven familial dystrophy...
October 2016: La Presse Médicale
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
Tai Fuchigami, Masahiko Nishioka, Toru Akashige, Shotaro Higa, Kazuhiro Takahashi, Mami Nakayashiro, Taisuke Nabeshima, Arata Sashinami, Kenzo Sakurai, Kiyotaka Takefuta, Nobuhiro Nagata
OBJECTIVES: Bilateral pulmonary artery banding (bPAB) is utilized for some patients with a ventricular septal defect (VSD) and aortic coarctation (CoA) or interrupted aortic arch (IAA). We evaluated aortic valve (AoV) diameter and patient outcomes following bPAB. METHODS: Between August 2010 and September 2015, 10 consecutive patients with VSD and patent ductus arteriosus-dependent CoA or IAA underwent bPAB because of an AoV diameter of approximately <50% of the normal value (n = 6), severe subaortic stenosis and poor patient condition (n = 1, respectively), or low birthweight (n = 2)...
November 2016: Interactive Cardiovascular and Thoracic Surgery
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
Jonathan W Weinsaft, Richard B Devereux, Liliana R Preiss, Attila Feher, Mary J Roman, Craig T Basson, Alexi Geevarghese, William Ravekes, Harry C Dietz, Kathryn Holmes, Jennifer Habashi, Reed E Pyeritz, Joseph Bavaria, Karianna Milewski, Scott A LeMaire, Shaine Morris, Dianna M Milewicz, Siddharth Prakash, Cheryl Maslen, Howard K Song, G Michael Silberbach, Ralph V Shohet, Nazli McDonnell, Tabitha Hendershot, Kim A Eagle, Federico M Asch
BACKGROUND: Aortic dissection (AoD) is a serious complication of thoracic aortic aneurysm (TAA). Relative risk for AoD in relation to TAA etiology, incidence, and pattern after prophylactic TAA surgery are poorly understood. OBJECTIVES: This study sought to determine the incidence, pattern, and relative risk for AoD among patients with genetically associated TAA. METHODS: The population included adult GenTAC participants without AoD at baseline...
June 14, 2016: Journal of the American College of Cardiology
2016-06-15 13:56:52
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