Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.
Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement. J Invasive Cardiol. 2019 Jul;31(7):E184-E191 Authors: Pineda AM, Rymer J, Wang A, Koweek LH, Williams A, Kiefer T, Wang A, Gaca J, Hughes GC, Harrison JK Abstract BACKGROUND: Alternative access (AA) is still required for a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare the clinical outcomes of patients undergoing AA vs transfemoral (TF) access. METHODS: We retrospectively evaluated the outcomes of patients undergoing AA-TAVR between April 2011 and November 2016, and compared them with those who had TF-TAVR. Chi-square and Mann-Whitney U-tests were used to compare the groups and Kaplan-Meier analysis was performed to estimate long-term survival. RESULTS: TAVR was performed in a total of 600 patients, of which 78 (13%) had AA and 522 (87%) had TF access. Patients undergoing AA were younger, and had higher prevalence of chronic obstructive pulmonary disease, peripheral vascular disease, prior myocardial infarction, and prior sternotomy. Greater than mild paravalvular regurgitation (4.2% vs 0.0%; P=.04) and unplanned vascular surgery (5.4% vs 1.3%; P=.09) were more frequent in the TF group. However, patients who underwent AA had longer hospital stay (median 4 days [interquartile range, 3-7 days] vs 3 days [interquartile range, 3-4 days]; P
CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis. PMID: 31596707 [PubMed - in process]
Conclusions: The direct analyses of emissions reductions estimate substantial health benefits via coal power plant emission and PM2.5 concentration reductions. Differing responses associated with changes in the two exposure metrics underscore the importance of isolating source-specific impacts from those due to total PM2.5 exposure.
The objective of our study was thus to investigate the incidence and prognostic impact of PPM after TAVI.MethodsOur analysis included 613 TAVI patients in whom the indexed effective orifice area (iEOA) after TAVI was obtained in vivo using echocardiography. Prosthesis sizing was guided by pre-procedural ECG-gated computed tomography. Based on VARC-2 established criteria for significant PPM (iEOA ≤ 0.85 cm2/m2 in the setting of BMI
ConclusionsIn this study with staged CAS followed by cardiac surgery, we confirm previously reported event ‐free survival rates and identify several risk factors for the composite outcome. Future studies are needed to confirm the importance of the identified risk factors and to assess their predictive ability.
Abstract There is increasing evidence that genetic variability influences patients' early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFLAmmation in Cardiac OpeRations) cohort. In a prospectively recruited cohort of 518 adult Polish Caucasians, who underwent cardiac surgery in which CPB was used, the clinical data, bio...
Objective. We evaluated the relationship between various risk scores (SYNTAX score (SS), SYNTAX score-II (SS-II), thrombolysis in myocardial infarction (TIMI) risk scores and Global Registry of Acute Coronary Events (GRACE) risk scores) and major adverse cardiovascular events (MACE) in non-ST-elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Subjects and Methods: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients,...
ConclusionsMultimorbidity among patients with AMI was common, and conferred an accumulative increased risk of death. Three multimorbidity phenotype clusters that were significantly associated with loss in life expectancy were identified and should be a concomitant treatment target to improve cardiovascular outcomes. Trial registrationClinicalTrials.gov NCT03037255.
CONCLUSIONS: Inaccuracies in EHR problem list-based comorbidity data can lead to incorrect determinations of case mix. Such data should be validated prior to application to risk adjustment. PMID: 29350512 [PubMed - in process]
Introduction: The prognosis of COPD patients is compromised by different comorbidities. There are only few data concerning chronic kidney disease (CKD) in these patients. We therefore analyzed CKD patients in the German COSYCONET cohort.Methods: CKD was defined by an eGFR
Conclusion This study aimed to see whether beta blockers reduce mortality in people who've had a heart attack but who don't have heart failure or systolic dysfunction. It found no difference between those who were and those who were not given beta-blockers on discharge from hospital. The authors say this adds to the evidence that routine prescription of beta blockers might not be needed for patients without heart failure following a heart attack. Current UK guidelines recommend all people who have had a heart attack take beta blockers for at least one year to reduce risk of recurrent events. Only people with heart failure ...