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Is There a Role for Vitamin K Antagonist in the Management of Atrial Fibrillation in 2023?
AbstractPurpose of ReviewTo address the following question: Are vitamin K antagonists (VKA) obsolete as stroke prevention therapy for patients with atrial fibrillation (AF) and thromboembolic risk factors?Recent FindingsA patient-level meta-analysis of the pivotal phase III randomized trials confirmed the favorable treatment effect of direct oral anticoagulants (DOAC) over VKA in multiple key patient subgroups. Among patients with AF and rheumatic heart disease (85% of whom had mitral stenosis), a randomized trial showed that rivaroxaban was not superior to VKA for stroke prevention. Caution should be exercised when prescr...
Source: Current Cardiology Reports - March 30, 2023 Category: Cardiology Source Type: research

Stroke and Noninfective Native Valvular Disease
AbstractPurpose of ReviewEmbolic stroke of undetermined source is a challenging clinical entity. While less common than atrial fibrillation and endocarditis, many noninfective heart valve lesions have been associated with stroke and may be considered as culprits for cerebral infarcts when other more common causes are excluded. This review discusses the epidemiology, pathophysiology, and management of noninfective valvular diseases that are commonly associated with stroke.Recent FindingsCalcific debris from degenerating aortic and mitral valves may embolize to the cerebral vasculature causing small- or large-vessel ischemia...
Source: Current Cardiology Reports - March 27, 2023 Category: Cardiology Source Type: research

The Global Impact of Rheumatic Heart Disease
AbstractPurpose of ReviewRheumatic heart disease (RHD) is a neglected disease of poverty, which presents challenges for patients, communities, and health systems. These effects are magnified in low resource countries, which bear the highest disease burden. When considering the impact of RHD, it is imperative that we widen our lens in order to better understand how RHD impacts the over 40 million people currently living with this preventable condition and their communities. We aimed to perform an updated literature review on the global impact of RHD, examining a broad range of aspects from disease burden to impact on health...
Source: Current Cardiology Reports - October 1, 2021 Category: Cardiology Source Type: research

What Is New in Low Gradient Aortic Stenosis: Surgery, TAVR, or Medical Therapy?
AbstractBackgroundA significant proportion of patients with aortic stenosis (AS) have discordance in severity by mean gradient/peak velocity and aortic valve area. Low gradient aortic stenosis (LG-AS) is defined when the aortic valve area is<  1 cm2 consistent with severe AS and mean aortic gradient is<  40 mmHg consistent with non-severe AS. LG-AS represents a diagnostic and therapeutic challenge.Purpose of ReviewTo summarize the different categories, diagnosis, management, and prognosis of LG-AS. LG-AS is classified as classical (ejection fraction (EF)<  50%, indexed stroke volume (SVi) <  35 ml/...
Source: Current Cardiology Reports - July 8, 2020 Category: Cardiology Source Type: research

Should All Low-risk Patients Now Be Considered for TAVR? Operative Risk, Clinical, and Anatomic Considerations
This article reviews the current data on TAVR in low-risk patients with severe, symptomatic aortic stenosis, highlights the results of the recently published Medtronic Low Risk Randomized Study and PARTNER 3 trials, and describes specific clinical, anatomic, and procedural considerations regarding the optimal treatment choice in this population.Recent FindingsIn low-risk patients, the Medtronic Low Risk Randomized Study demonstrated TAVR to be non-inferior to surgery with respect to the composite endpoint of death or disabling stroke while PARTNER 3 trial proved TAVR to be superior to surgery with regard to the composite e...
Source: Current Cardiology Reports - November 27, 2019 Category: Cardiology Source Type: research

The Lotus Valve System: an In-depth Review of the Technology
AbstractPurpose of ReviewInnovation for transcatheter aortic valve replacement (TAVR) has transformed a medically complex treatment into a standardized procedure. While Edwards SAPIEN and Medtronic CoreValve occupy the market for TAVR in the United States (US), additional valve systems are being developed. The Boston Scientific Lotus Valve system was recently FDA-approved and will represent the third valve in the US market. This evidence-based review will summarize advantages, disadvantages, and projected impact of this new TAVR system.Recent FindingsThe Lotus Valve system demonstrates superiority in terms of rates of para...
Source: Current Cardiology Reports - November 24, 2019 Category: Cardiology Source Type: research

Current Role of the Total Artificial Heart in the Management of Advanced Heart Failure
AbstractThe total artificial heart (TAH) is a form of mechanical circulatory support that involves resection of the native ventricles followed by placement of a device that can restore total pulmonary and systemic flow. Given the increasing burden of congestive heart failure and cardiovascular disease, the number of people in need of cardiac replacement therapy will continue to grow. Despite aggressive efforts to expand the donor pool, the number of heart transplants in the United States (US) has plateaued at less than 3000 per year. In addition, there is increasing recognition of the long-term complications of current gen...
Source: Current Cardiology Reports - November 21, 2019 Category: Cardiology Source Type: research

Protection from Cerebral Embolic Events During Transcatheter Aortic Valve Replacement
Abstract Transcatheter aortic valve replacement (TAVR) has been a major advancement in the treatment of high-risk patients with severe aortic stenosis. One of the primary concerns in applying this procedure to a broader patient population is the risk of embolic stroke. Cerebral emboli have been shown to originate from atheromatous plaques within the aorta and from the degenerate stenotic aortic valve itself. Thus, there has been significant interest in embolic protection devices designed to either filter or deflect potential cerebral emboli during TAVR. Here, we review the rationale and current data for embolic p...
Source: Current Cardiology Reports - January 14, 2016 Category: Cardiology Source Type: research