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Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement: How Would You Manage This Patient With Severe Aortic Stenosis? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Ann Intern Med. 2021 Apr 13. doi: 10.7326/M21-0724. Online ahead of print.ABSTRACTAortic stenosis (AS) is common, especially among the elderly. Left untreated, severe symptomatic AS is typically fatal. Surgical aortic valve replacement (SAVR) was the standard of care until transcatheter aortic valve replacement (TAVR) was shown to have lower mortality rates in patients at the highest surgical risk and was recommended for this group in the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines. In the 2017 AHA/ACC focused update, evidence of benefit and noninferiority extended the use of TAVR to...
Source: Annals of Internal Medicine - April 12, 2021 Category: Internal Medicine Authors: Eileen E Reynolds Suzanne J Baron Tsuyoshi Kaneko Howard Libman Source Type: research

Transesophageal echocardiography (TEE) in the detection of intraoperative cardiac arrest: A case report
Rationale: Point-of-care ultrasound is widely used in patients with cardiac arrest, allowing for diagnosing, monitoring, and prognostication as well as assessing the effectiveness of the chest compressions. However, the detection of intraoperative cardiac arrest by Point-of-care ultrasound was rarely reported. Patient concerns: A 21-year-old male with Marfan syndrome which manifested Valsalva sinus aneurysms was admitted for aortic valve replacement. After endotracheal intubation, TEE transducer was inserted to evaluate the cardiac structure and function with different views. Severe aortic valve regurgitation was obse...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Cerebral Embolic Protection Devices in Transcatheter Aortic Valve Replacement —Effective in Stroke Prevention?
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for severe symptomatic aortic stenosis. Despite advances in device technology and procedural techniques, periprocedural stroke remains a severe complication of TAVR, affecting 2% of patients. The embolization of calcific debris from the degenerated aortic valve and atherosclerotic plaque from the aorta, both of which are manipulated during TAVR, is the likely mechanism of periprocedural stroke. Accordingly, cerebral embolic protection devices (EPDs) have been designed to prevent stroke by sequestering embolic debris during TAVR.
Source: JAMA Internal Medicine - February 24, 2020 Category: Internal Medicine Source Type: research

Impact of Stroke Volume Index and Left Ventricular Ejection Fraction on Mortality After Aortic Valve Replacement
To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR).
Source: Mayo Clinic Proceedings - December 31, 2019 Category: Internal Medicine Authors: Saki Ito, Vuyisile T. Nkomo, David A. Orsinelli, Grace Lin, Joao Cavalcante, Jeffrey J. Popma, David H. Adams, Stanley J. Checuti, G. Michael Deeb, Michael Boulware, Jian Huang, Stephen H. Little, Sidney A. Cohen, Michael J. Reardon, Jae K. Oh Tags: Original article Source Type: research

“A contemporary description of staphylococcus aureus prosthetic valve endocarditis. Differences according to the time elapsed from surgery”
Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity. This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016. Fifty percent had a Charlson Index score>5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic s...
Source: Medicine - August 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

The safety of concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: A systematic review and meta-analysis
Conclusion: These data did not show a significant difference in short-term outcomes between concomitant PCI and TAVR versus staged PCI and TAVR.
Source: Medicine - December 1, 2017 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Transfemoral transcatheter aortic-valve replacement should be preferred over surgery in most intermediate-risk patients
Commentary on: Leon MB, Smith CR, Mack MJ, et al.., PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016;374:1609–20 . Context Evidence derived from randomised clinical trials support transcatheter aortic valve replacement (TAVR) as a choice for patients with aortic stenosis with a prohibitive surgical risk and as a valid alternative therapy for those at high-risk of surgical mortality. Owing to increases in operator experience as well as improvements with transcatheter techniques and devices associated with reduction in procedural complications,...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Tamburino, C., Capranzano, P. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research

Sex-Specific Differences at Presentation and Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement: A Cohort Study.
Conclusion: Despite a higher incidence of vascular and bleeding complications, women having TAVR had lower mortality than men at 1 year. Thus, sex-specific risk in TAVR is the opposite of that in SAVR, for which female sex has been shown to be independently associated with an adverse prognosis. Primary Funding Source: Edwards Lifesciences. PMID: 26903039 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - February 23, 2016 Category: Internal Medicine Authors: Kodali S, Williams MR, Doshi D, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, Douglas PS, Mack M, Xu K, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Leon M, Kirtane AJ Tags: Ann Intern Med Source Type: research

At 5 years, transcatheter aortic valve replacement had similar rates of mortality and stroke as surgical aortic valve replacement in high-risk patients
Commentary on: Kapadia SR, Leon MB, Makkar RR, et al., PARTNER trial investigators. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015;385:2485–91 and Mack MJ, Leon MB, Smith CR, et al., PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER1): a randomised controlled trial. Lancet 2015;385:2477–84. Context When calcific aortic stenosis is as...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Reardon, M. J., Kleiman, N. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Interventional cardiology, Valvar diseases Therapeutics/Prevention Source Type: research

Outcomes of Transcatheter Aortic Valve Implantation in High Surgical Risk and Inoperable Patients with Aortic Stenosis ‐ A Single Australian Centre Experience
ConclusionsTAVI with various valve systems, delivered via a number of approaches, is feasible in high surgical risk and inoperable patients with severe aortic stenosis, with acceptable outcomes at short‐ and intermediate‐term follow‐up.
Source: Internal Medicine Journal - October 1, 2015 Category: Internal Medicine Authors: Vijayakumar Subban, Dale Murdoch, Michael L Savage, James Crowhurst, Ramakrishna Saireddy, Karl K Poon, Alexander Incani, Nicholas Bett, Darryl J Burstow, Gregory M Scalia, Andrew Clarke, Owen Christopher Raffel, Constantine N Aroney, Darren L Walters Tags: Original Article Source Type: research

Presentation on US Hospital Websites of Risks and Benefits of Transcatheter Aortic Valve Replacement Procedures
Adequate presentation of risks and benefits of medical therapies is essential to informed decision making by patients. Transcatheter aortic valve replacement (TAVR) has been recently approved by the US Food and Drug Administration for the treatment of severe aortic stenosis among carefully selected patients; recent randomized clinical trials have identified important positive and negative outcomes of TAVR in these populations, including twice the risk of stroke for patients undergoing TAVR vs those undergoing open aortic valve replacement. Since 78% of all adults in the United States seek out health information online, we ...
Source: JAMA Internal Medicine - January 12, 2015 Category: Internal Medicine Source Type: research

Aortic valve surgery in octogenarians: Risk factors and long-term impact
Conclusions The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival.
Source: Revista Clinica Espanola - November 6, 2014 Category: Internal Medicine Source Type: research

Novel anticoagulants in patients with mechanical heart valves
Commentary on: Eikelboom JW, Connolly SJ, Brueckmann M, et al.. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 2013;369:1206. Context Novel anticoagulants (including the direct thrombin inhibitor dabigatran etixilate) and oral factor Xa inhibitors have similar or superior efficacy and safety to warfarin for reducing thromboembolic stroke in patients with atrial fibrillation, and for prevention of deep venous thrombosis. Eikelboom and colleagues set out to examine whether these novel anticoagulants could be used as an alternative to warfarin in patients with mechanical heart valves. Method...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Stewart, R. A. H. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism Therapeutics Source Type: research

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