Two-year outcomes from the PARTNER 3 trial: where do we stand?
Purpose of review
The PARTNER 3 trial was conducted to compare outcomes after transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve and surgical aortic valve replacement (SAVR) in individuals at low surgical risk with aortic stenosis. Recently reported rates of death, stoke and valve thrombosis in the TAVR arm have raised concerns about the longevity of this intervention in low-risk individuals. It is incumbent on all members of the Heart Team to understand the potential consequences of these findings.
Recent findings
TAVR was initially superior to SAVR at 1 year for a primary composite e...
Source: Current Opinion in Cardiology - February 12, 2021 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Review of transapical off-pump mitral valve intervention with NeoChord implantation
Purpose of review
Mitral valve repair surgery has recently shifted from resection-based techniques to leaflet sparing approaches using synthetic neochordae. This has facilitated the growth of a new strategy of transapical off-pump mitral valve intervention with neochord implantation.
Recent findings
Minimally invasive approaches for mitral valve repair with robotic or video-assisted mini-right anterolateral thoracotomy have been developed to mitigate the morbidity associated with conventional median sternotomy. Recently, an alternative, less invasive surgical strategy has emerged. This transapical off-pump techn...
Source: Current Opinion in Cardiology - February 12, 2021 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Resurgence of the edge-to-edge repair of the mitral valve
Purpose of review
To provide a critical review of the application and outcomes of surgical edge-to-edge (E2E) or Alfieri repair for mitral valvulopathy.
Recent findings
The E2E repair is a surgical technique to address mitral regurgitation, particularly suited when the responsible mechanism is bileaflet prolapse combined with enlarged annular area. It can also be used for a range of mitral valve pathologies. Surgically, the technique has been employed as a bailout for unsuccessful repair including residual mitral regurgitation because of systolic anterior motion (SAM). E2E repair should be accompanied by a ring ...
Source: Current Opinion in Cardiology - February 12, 2021 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Antithrombotic therapy after transcatheter aortic valve replacement: current perspective
Purpose of review
Transcatheter aortic valve replacement (TAVR) has expanded as a treatment option for severe aortic stenosis throughout the surgical risk spectrum. Decreasing procedural risk and inclusion of lower risk population has shifted the focus to optimization of postprocedural management and balancing the thrombotic and bleeding complications. In this review, we outline various patient and procedure related factors affecting choice of antithrombotic therapy post TAVR and provide an update of recent development in this area.
Recent findings
Multiple studies have confirmed the high incidence of both ische...
Source: Current Opinion in Cardiology - February 12, 2021 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - February 12, 2021 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
COVID-19 will forever change the landscape of telemedicine
This article discusses novel ways of using telehealth during the current pandemic and measures that would need to be taken to sustain telehealth and teleconsultations.
Recent findings
Telehealth has expanded to outpatient pediatric cardiology clinics across the globe during the pandemic. Technological advancements in video conferencing and the abundance of readily available wearable devices have allowed cardiologists to establish a preliminary diagnosis and set forth a treatment plan. Additional support by insurance providers and relaxation of mandatory regulations by the government have allowed telehealth to succee...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Culture, teamwork and engagement: 40 years of finding the right ingredients
Purpose of review
Changing demands in healthcare, new leadership structures and physician preferences on work-life balance have made culture, teamwork and engagement vitally important for the long-term success of medical practices. With recent emphasis placed on culture, teamwork and engagement, leaders have had to acquire management skills that extend beyond the scope of being a successful clinician, educator and researcher.
Recent findings
Over the last two decades, experts throughout the business and medical fields have worked to define culture. Furthermore, these authors have shown that success in businesses...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Health anxiety among adults with congenital heart disease
Purpose of review
Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients.
Recent findings
Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Improving outcomes collaboratively with families: what works and what doesn’t
Purpose of review
As attention begins to shift from short-term surgical outcomes to long-term clinical and quality of life outcomes, patients and families are becoming increasingly responsible for outcomes. For this reason, it is essential to effectively include them in the outcome planning, goal setting, and evaluation processes.
Recent findings
There are a number of tools and strategies available to maximize patient engagement. These must be employed in direct patient care and system and policy conversations, for meaningful patient partnerships that can lead to improved outcomes.
Summary
As we move from...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Delivering pediatric cardiac care in sub-Saharan Africa: a model for the developing countries
Purpose of review
It is projected that by 2050, around 40% of all births, and about 40% of all children, will be in Africa, up from about 10% in 1950. Consequently, this trend will cause an increase in noncommunicable diseases in children, such as congenital and rheumatic heart diseases. The current state of pediatric cardiac care in sub-Saharan Africa is dire with some countries without cardiac surgical services at all. The purpose of this review is to highlight those components needed to build a sustainable model for a pediatric cardiac care center in sub-Saharan Africa.
Recent findings
Review of the literatur...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Newer risk assessment strategies in hypertrophic cardiomyopathy
Purpose of review
The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed.
Recent findings
Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particular...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Update on pediatric pulmonary arterial hypertension
Purpose of review
Pulmonary arterial hypertension (PAH) causes high morbidity and mortality in children. In this review, we discuss advances in diagnosis and treatment of this disorder.
Recent findings
Proceedings published from the 2018 World Symposium updated the definition of pulmonary hypertension to include all adults and children with mean pulmonary artery pressure more than 20 mmHg. Targeted PAH therapy is increasingly used off-label, but in 2017, bosentan became the first Food and Drug Administration-targeted PAH therapy approved for use in children.
Summary
In recent years, advanced imaging and...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Calmodulinopathies: throwing back the veil on the newest life-threatening genetic arrhythmia syndrome
Purpose of review
This review provides a basic understanding of the calmodulin gene and its role in calcium homeostasis. We outline the functional effects and clinical expression of CALM mutations and review disease expression and management.
Recent findings
Calmodulinopathies are rare life-threatening arrhythmia syndromes affecting young individuals. They are caused by mutations in any of the three genes (CALM 1-3) that encode calmodulin (CaM), a ubiquitously expressed Ca2+ signaling protein with multiple targets that in the heart, modulates several ion channels. Patients express varied phenotypes: long QT synd...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
The placenta as the window to congenital heart disease
This article reviews the role of the placenta and the potential impact of placental insufficiency on fetuses with congenital heart disease.
Recent findings
The fetal heart and the placenta are directly linked because they develop concurrently with shared regulatory and signaling pathways. Placental disease is more common in pregnancies carrying a fetus with congenital heart disease and the fetal response to placental insufficiency may lead to the postnatal persistence of cardiac remodeling. The mechanisms underlying this placental–fetal axis of interaction potentially include genetic factors, oxidative stress, chr...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell I. Cohen Source Type: research
Telemedicine in cardiac procedures: considerations for a remote future
Purpose of review
Present a review of relevant literature and suggest a framework for discussion of the considerations affecting the evolution and adoption of Telerobotic Support and Telerobotic Collaboration in the practice of cardiac procedural medicine.
Recent findings
Recent medical practice has undergone remarkable transformation in the adoption of telemedicine. This evolution has been accelerated by the COVID-19 (SARS-CoV-2) pandemic and has largely been focused on outpatient medicine. Clinical studies and opinion articles have highlighted benefits including reduced costs, increased patient engagement, and...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
