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Renker M, Charitos EI, Choi YH, Sossalla S. [Catheter-based and surgical treatment for aortic valve diseases]. Inn Med (Heidelb) 2024; 65:431-438. [PMID: 38635087 DOI: 10.1007/s00108-024-01699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
The pathophysiology of aortic valve diseases is of predominantly degenerative nature, characterized by calcific aortic valve stenosis, which is associated with a reduction in prognosis. The prevalence of aortic valve insufficiency also increases with advancing age. Timely causal treatment is crucial in the management of aortic valve diseases. Following the indication for intervention, the heart team plays a central role in evaluating the results and making therapeutic decisions that consider the patient's preferences. In the assessment of treatment options, considerations regarding the long-term perspective are particularly crucial, especially in younger patients. The most common therapeutic approach for aortic valve diseases is the introduction of a new valve prosthesis. In the majority of cases, this is now achieved through catheter-based implantation of a bioprosthetic heart valve, known as transcatheter aortic valve implantation (TAVI). Open surgical aortic valve replacement (AVR) is favored in younger patients with low surgical risk or in the case that TAVI is not feasible. In AVR, both biological and the longest-lasting mechanical prosthesis types are used. Surgical repair techniques are primarily applied in cases of aortic valve regurgitation. Notably, TAVI, as well as surgical procedures for the treatment of aortic valve diseases, have undergone significant advancements in recent years, including expanded indications for TAVI and, on the surgical side, in particular the development of minimally invasive surgical techniques.
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Affiliation(s)
- Matthias Renker
- Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | | | - Yeong-Hoon Choi
- Abteilung Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Samuel Sossalla
- Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
- Medizinische Klinik I, Abteilung Kardiologie und Angiologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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2
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Cheng AM, Doll JA. When to Consider Coronary Revascularization for Stable Coronary Artery Disease. Med Clin North Am 2024; 108:517-538. [PMID: 38548461 DOI: 10.1016/j.mcna.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Revascularization is an effective adjunct to medical therapy for some patients with chronic coronary disease. Despite numerous randomized trials, there remains significant uncertainty regarding if and how to revascularize many patients. Coronary artery bypass grafting is a class I indication for patients with significant left main stenosis or multivessel disease with ejection fraction ≤ 35%. For other patients, clinicians must carefully consider the potential benefits of symptom improvement and reduction of future myocardial infarction or CV death against the risk and cost of revascularization. Although guidelines provide a framework for these decisions, each individual patient will have distinct coronary anatomy, clinical factors, and preferences.
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Affiliation(s)
- Andrew M Cheng
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Section of Cardiology, VA Puget Sound Health Care System, 1660 South Columbian Way S111-CARDIO, Seattle, WA 98108, USA.
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3
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Rheude T, Pellegrini C, Xhepa E, Joner M. [Update on the treatment of aortic valve stenosis in symptomatic and asymptomatic patients]. Herz 2024; 49:156-164. [PMID: 38240775 DOI: 10.1007/s00059-023-05229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 03/07/2024]
Abstract
Aortic valve stenosis is one of the most frequent valvular heart diseases requiring treatment in industrialized countries. The symptom onset is associated with a significantly increased mortality, so that there is a clear indication for treatment in patients with severe, symptomatic aortic valve stenosis; however, data on the optimal treatment of patients with asymptomatic aortic valve stenosis are scarce. Smaller studies in the field of cardiac surgery suggest that early surgical valve replacement is superior to a conservative approach. For this reason, the results of additional adequately powered randomized trials are awaited with great interest. In this year numerous long-term results from randomized comparisons of the two available treatment options (surgical versus transcatheter aortic valve replacement) were published, which will further guide the heart team to find the best treatment approach for each individual.
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Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland.
- DZHK (Deutsches Zentrum für Herzkreislaufforschung), partner site Munich Heart Alliance, München, Deutschland.
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Thuan PQ, Chuong PTV, Thang HD, Nhiem DL, Nam NH, Dinh NH. Successful surgical management of large pulmonary artery thrombosis in a patient with primary severe mitral regurgitation and complex congenital heart disease: A case report. Int J Surg Case Rep 2024; 114:109159. [PMID: 38109800 PMCID: PMC10767183 DOI: 10.1016/j.ijscr.2023.109159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Pulmonary artery thrombosis presents a rare and formidable challenge, especially in individuals with untreated complex congenital heart diseases and concurrent valvular abnormalities. PRESENTATION OF CASE This case details a distinctive instance of pulmonary artery thrombosis in a patient with untreated congenital atrial septal defect, severe pulmonary hypertension, pulmonary aneurysm, valvular heart disease, and triple-positive antiphospholipid antibodies. Collaborative decision-making by a heart team guided the diagnostic and therapeutic processes, resulting in surgical interventions encompassing pulmonary thrombectomy, mitral and tricuspid regurgitation repair, and atrial septal defect closure. DISCUSSION The case underscores the nuanced management of pulmonary artery thrombosis within the realm of congenital heart disease, highlighting the imperative role of a multidisciplinary approach in achieving accurate diagnoses and timely interventions. The multifaceted treatment strategy implemented further accentuates the need for continual monitoring and personalized interventions in intricate clinical scenarios. CONCLUSION In conclusion, this case emphasizes the complexity of addressing pulmonary artery thrombosis in the context of congenital heart disease. The collaborative efforts of a multidisciplinary team proved pivotal in navigating diagnostic uncertainties and formulating a tailored treatment plan. Ongoing monitoring and personalized strategies remain crucial for optimizing outcomes in such intricate cases.
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Affiliation(s)
- Phan Quang Thuan
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Pham Tran Viet Chuong
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Ho Duc Thang
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Dinh Long Nhiem
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
| | - Nguyen Hoang Dinh
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam; Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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Kruit N, Hambly J, Ong A, French J, Bowcock E, Kushwaha V, Jain P, Dennis M. Protocolised Management of Cardiogenic Shock and Shock Teams: A Narrative Review. Heart Lung Circ 2023; 32:1148-1157. [PMID: 37813747 DOI: 10.1016/j.hlc.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023]
Abstract
Despite advances in therapy, the incidence of cardiogenic shock continues to increase, with significant mortality that has improved minimally over time. Treatment options for cardiogenic shock are complex and time-, resource-, and case volume-dependent, and involve multiple medical specialties. To provide early, more equitable, and standardised access to cardiogenic shock expertise with advanced therapies, cardiogenic shock teams with a protocolised treatment approach have been proposed. These processes have been applied across hospitals into integrated cardiogenic shock networks. This narrative review evaluates the role of cardiogenic shock teams, protocolised and regionalised shock networks, and the main individual components of protocolised shock management approaches.
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Affiliation(s)
- Natalie Kruit
- Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James Hambly
- Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Ong
- Westmead Hospital, Sydney, NSW, Australia
| | - John French
- Liverpool Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Emma Bowcock
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Nepean Hospital, Sydney, NSW, Australia
| | - Virag Kushwaha
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaj Jain
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mark Dennis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Trimaille A, Matsushita K, Marchandot B, Carmona A, Hess S, Reydel A, Faucher L, Granier A, Mai TA, Diop B, Ohlmann P, Jesel L, Morel O. Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement. Arch Cardiovasc Dis 2023:S1875-2136(23)00165-1. [PMID: 37758593 DOI: 10.1016/j.acvd.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting. AIM To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement. METHODS All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure. RESULTS A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02). CONCLUSIONS Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Sebastien Hess
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Antje Reydel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Loic Faucher
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Amandine Granier
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Trung Anh Mai
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Bamba Diop
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
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Imran Hamid U, Modine T, Maessen J, van ‘t Hof A, Sondergaard L, Bleiziffer S, Lancellotti P, Siepe M, Sardari Nia P. Structure of multidisciplinary heart teams, a survey-based heart team study. Interdiscip Cardiovasc Thorac Surg 2023; 37:7241522. [PMID: 37567588 PMCID: PMC11015317 DOI: 10.1093/icvts/ivad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real-world practice of heart teams across Europe. METHODS The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologists identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. A total of 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty-seven (56%) of the respondents reported 10-20% of patients undergoing percutaneous coronary intervention were discussed at the heart team meeting. Seventy-nine (47%) respondents had ad hoc percutaneous coronary intervention institutional guidelines. Fifty-four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on the composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes.
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Affiliation(s)
- Umar Imran Hamid
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arnoud van ‘t Hof
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sabine Bleiziffer
- Department of Cardiac Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Centre, Inselspital, University of Bern, Switzerland
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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Negri F, De Bellis A, Burelli M, Poli S, De Pellegrin A, Vendramin I, Sponza M, Frigatti P, Imazio M, Livi U. When Heart Team Really Counts: Radical Excision of Intracardiac Leiomyomatosis. Cardiovasc Revasc Med 2023; 53S:S203-S206. [PMID: 36137908 DOI: 10.1016/j.carrev.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
Intravenous leiomyomatosis (IVL) are rare and complex tumors, characterized by high rates of recurrences after surgical removal and the capability of multi-organ involvement including pulmonary embolization. Regarding the surgical treatment of Intracardiac Leiomiomatosis (ICL), only few articles have been published and no controlled data are available. A combined approach that involves a Team of Cardiologists, Heart Surgeons, Vascular surgeons and Radiologists seems to be successful in treating ICL.
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Affiliation(s)
- Francesco Negri
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Udine, Italy.
| | - Annamaria De Bellis
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Massimo Burelli
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Stefano Poli
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Alessandro De Pellegrin
- Laboratory Department of Medical and Biological Science, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Igor Vendramin
- Division of Cardiac Surgery, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Massimo Sponza
- Radiology Department, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Paolo Frigatti
- Department of Vascular Surgery, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Massimo Imazio
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Ugolino Livi
- Division of Cardiac Surgery, Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
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Ibrahim H, Lowenstern A, Goldsweig AM, Rao SV. Integrating Structural Heart Disease Trainees within the Dynamics of the Heart Team: The Case for Multimodality Training. Struct Heart 2023; 7:100167. [PMID: 37273858 PMCID: PMC10236781 DOI: 10.1016/j.shj.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/02/2023] [Indexed: 06/06/2023]
Abstract
Structural heart disease is a rapidly evolving field. However, training in structural heart disease is still widely variable and has not been standardized. Furthermore, integration of trainees within the heart team has not been fully defined. In this review, we discuss the components and function of the heart team, the challenges of current structural heart disease models, and possible solutions and suggestions for integrating trainees within the heart team.
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Affiliation(s)
- Homam Ibrahim
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Angela Lowenstern
- Division of Cardiology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew M. Goldsweig
- Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts, USA
| | - Sunil V. Rao
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA
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Elbayomi M, Weyand M, Nooh E, Harig F. The lost balloon at midnight: a case report reveals the inevitability of heart team existence. J Cardiothorac Surg 2023; 18:102. [PMID: 37024888 PMCID: PMC10080842 DOI: 10.1186/s13019-023-02202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Dislodgement of a coronary stent-balloon catheter during percutaneous coronary intervention (PCI) is rare but is a life-threatening complication. A 57- year-old male presented with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography revealed total thrombotic occlusion of the Right coronary artery (RCA). Following the balloon dilatation of the RCA and while trying to retrieve the balloon catheter, the balloon was dislodged from the catheter shaft and entrapped in the coronary vessel. Under cardiopulmonary bypass, with antegrade cardioplegic arrest, the balloon was extracted through a coronary arteriotomy. Right coronary revascularization was done with reversed saphenous vein graft (SVG). DISCUSSION Given the variety of equipment that can be retained in the coronary artery and the multitude of mechanisms by which it may be entrapped, there are no straightforward techniques applicable to all situations. Specific guidelines or recommendations on properly managing these potentially life-threatening complications do not exist. However, the most crucial issue in the management of these cases is the hemodynamic status of the patient as well as the coronary flow in the vessel with entrapped device or stent. In our case, the RCA was retrogradely perfused from the left coronary artery, which provided time to transfer the patient to cardiovascular surgical backup.
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Affiliation(s)
- Mohamed Elbayomi
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Michael Weyand
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Ehab Nooh
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Frank Harig
- Department of Cardiovascular Surgery, Friedrich-Alexander-University, Krankenhausstr. 12, 91054, Erlangen, Germany
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11
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Mizuno T, Goya M, Fujiwara T, Oishi K, Takeshita M, Yashima M, Nagaoka E, Oi K, Sasano T. Surgical extraction of cardiac implantable electronic device leads based on a heart team approach. J Cardiol 2023; 81:111-116. [PMID: 36229301 DOI: 10.1016/j.jjcc.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND As cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy. This study aimed to investigate the validity of this heart team decision-making. METHODS From 2013 to 2021, 384 consecutive patients underwent lead extraction at our institution. RESULTS SLE was proposed as the primary intervention for 21 patients who had high risk of bleeding, difficult TVLE conditions, large vegetations, and other concomitant cardiac diseases. Of the 363 TVLE patients, 10 patients required surgical intervention; 5 had TVLE difficulty followed by SLE and 5 had excessive bleeding. SLE was performed in 26 patients, 19 of whom required valve surgery, and 8 required plication of the great veins. In 4 of the 17 hybrid procedures with SLE and TVLE, excessive bleeding occurred due to laceration of the superior vena cava and innominate vein. Operative mortality was not observed in SLE patients but was observed in 1 of the 4 TVLE patients who required emergent open-chest hemostasis. CONCLUSIONS The heart team discussion was essential to provide optimal treatment and maintain medical safety policies for each patient. SLE should be selected for patients with high risk of TVLE or other cardiac complications such as tricuspid valve incompetence.
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Affiliation(s)
- Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan; Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Masahiko Goya
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Takeshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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van Beek-Peeters JJAM, van den Ende Z, Faes MC, de Vos AJBM, van Geldorp MWA, Van den Branden BJL, van der Meer BJM, Minkman MMN. Decision making in treatment of symptomatic severe aortic stenosis: a survey study in Dutch heart centres. Neth Heart J 2022; 30:423-428. [PMID: 35380417 PMCID: PMC9402830 DOI: 10.1007/s12471-022-01676-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting. Supplementary Information The online version of this article (10.1007/s12471-022-01676-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Z van den Ende
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | | | - M W A van Geldorp
- Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - B J M van der Meer
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
- Board of Directors, Catharina Hospital, Eindhoven, The Netherlands
| | - M M N Minkman
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
- Vilans, Centre of Expertise for Long-term Care, Utrecht, The Netherlands
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13
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van den Heuvel FMA, Bos M, Geuzebroek GSC, Aarntzen EHJG, Maat I, Dieker HJ, Verkroost M, Rodwell L, Ten Oever J, van Crevel R, Habets J, Kouijzer IJE, Nijveldt R. The impact of implementing an endocarditis team in comparison to the classic heart team in a tertiary referral centre. BMC Cardiovasc Disord 2022; 22:114. [PMID: 35300594 PMCID: PMC8931961 DOI: 10.1186/s12872-022-02558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infective endocarditis (IE) is a complex disease for which the European Society of Cardiology guideline recommends a dedicated multidisciplinary endocarditis team (ET) approach since 2015. It is currently unknown whether this ET approach is beneficial compared to a classic heart team approach including bedside consultation by an infectious disease specialist in Western Europe. Methods This retrospective single centre, observational cohort study was conducted at the Radboudumc, a tertiary referral centre in the Netherlands. Consecutive patients treated for IE were included from September 2017 to September 2018 before implementation of a dedicated ET and from May 2019 to May 2020 afterwards. Results In total, 90 IE patients (45 patients before and 45 patients after the implementation of the ET) were included. No significant differences were found in diagnostic workup, surgical treatment (surgery performed 69% vs. 71%, p = 0.82), time to surgery because of an urgent indication (median 4 vs. 6 days, p = 0.82), in-hospital complications (53% vs. 67%, p = 0.20), and 6-month mortality (11% vs. 13%, p = 0.75) between IE patients treated before and after the implementation of the ET. Conclusion Formalization of the recommended multidisciplinary endocarditis team might not significantly improve the complication rate nor the short term outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02558-0.
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Affiliation(s)
- F M A van den Heuvel
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands.
| | - M Bos
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Maat
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H J Dieker
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Rodwell
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Habets
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
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14
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Wilson T, Richards L, Bajwa T, Galazka P, Jahangir A, Fischer W, Muthukumar L. Percutaneous Removal of Epicardial Pacing Wire: Nidus for Infective Endocarditis. CASE (Phila) 2022; 6:13-15. [PMID: 35243193 PMCID: PMC8883062 DOI: 10.1016/j.case.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Retained TEPW is fairly common and in rare cases may cause infective endocarditis. Obtaining medical records and using multimodality imaging confirmed diagnosis. The heart team assured full understanding of treatment options to reduce patient risk. Right-side endocarditis caused by retained TEPW was treated without redo sternotomy.
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Affiliation(s)
- Thomas Wilson
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Lauren Richards
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - William Fischer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
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15
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Andreini D, Takahashi K, Mushtaq S, Conte E, Modolo R, Sonck J, De Mey J, Ravagnani P, Schoors D, Maisano F, Kaufmann P, Lindeboom W, Morel MA, Doenst T, Teichgräber U, Pontone G, Pompilio G, Bartorelli A, Onuma Y, Serruys PW. Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial. Interact Cardiovasc Thorac Surg 2022; 34:176-184. [PMID: 34542612 PMCID: PMC8766208 DOI: 10.1093/icvts/ivab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/13/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team's treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease. METHODS SYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications. RESULTS Overall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived-ICA derived) was lower in patients without heavy calcifications [mean (-1.96 SD; +1.96 SD) = 1.5 (-19.3; 22.4) vs 5.9 (-17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen's kappa 0.79) or without coronary calcifications (Cohen's kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%). CONCLUSIONS An overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions.
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Affiliation(s)
- Daniele Andreini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Saima Mushtaq
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Edoardo Conte
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rodrigo Modolo
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
- Cardiology Division, Department of Internal Medicine, Hospital de Clinicas, University of Campinas, Campinas, São Paulo, Brazil
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Paolo Ravagnani
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | | | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulf Teichgräber
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giulio Pompilio
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonio Bartorelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | | | - Patrick W Serruys
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK
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16
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Basman C, Pirelli L, Singh VP, Reimers CD, Hemli J, Brinster DR, Patel NC, Scheinerman SJ, Kliger CA. Lifetime management for aortic stenosis: Planning for future therapies. J Cardiol 2022; 80:185-189. [PMID: 35016808 DOI: 10.1016/j.jjcc.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
A shift to lifetime management has gained more focus with the approval of low-risk transcatheter aortic valve replacement (TAVR). This paper is therefore focused on the different approaches for lifetime management. Herein we discuss the procedural safety, durability, performance, and future options for each lifetime management strategy. In younger patients that elect to undergo surgical aortic valve replacement (SAVR), options for bioprosthetic failure are TAV-in-SAV or redo SAVR. Among patients that undergo TAVR, options for valve failure include TAVR explant with SAVR or TAV-in-TAV. Additionally, there are patients who may require a third valvular intervention. The initial therapy may limit re-intervention options down the road. This review discusses how options for future therapies affect the decision of SAVR vs TAVR in younger patients.
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Affiliation(s)
- Craig Basman
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA; Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA.
| | - Luigi Pirelli
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Varinder P Singh
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA; Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA
| | - Carl D Reimers
- Department of Cardiology, Northern Westchester Hospital/Northwell Health, Mount Kisco, NY, USA
| | - Jonathan Hemli
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Derek R Brinster
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Nirav C Patel
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - S Jacob Scheinerman
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
| | - Chad A Kliger
- Department of Cardiology and Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY, USA
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17
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Veronese ET, Pomerantzeff PMA, Jatene FB. Improving the heart team: An interdisciplinary team and integrated practice unit. World J Cardiol 2021; 13:650-653. [PMID: 35070109 PMCID: PMC8716975 DOI: 10.4330/wjc.v13.i12.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/02/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Heart Team emerged as an important tool in the cardiovascular care, improving the efficiency of decision-making process. In addition to the benefits in patient care, it symbolizes a new culture and mindset. However, beyond the clinical condition, in low/middle-income countries other concerns arise regarding patient's background and these demands are, usually, as challenging as the medical treatment. New models have been proposed face these demands and to assure a holistic care by Integrated Practice Units. Optimization and reorganization of already existing resources and promotion of interdisciplinary and holistic care may be an effective manner to improve outcomes despite socioeconomic barriers.
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Affiliation(s)
- Elinthon Tavares Veronese
- Department of Cardiovascular Surgery, Heart Institute - University of São Paulo Medical School, São Paulo 05403-900, SP, Brazil
| | | | - Fábio Biscegli Jatene
- Department of Cardiovascular Surgery, Heart Institute - University of São Paulo Medical School, São Paulo 05403-900, SP, Brazil
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18
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Saku K, Yokota S, Nishikawa T, Kinugawa K. Interventional heart failure therapy: A new concept fighting against heart failure. J Cardiol 2021; 80:101-109. [PMID: 34924236 DOI: 10.1016/j.jjcc.2021.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Heart failure is a progressive disease that is associated with repeated exacerbations and hospitalizations. The rapid increase in the number of heart failure patients is a global health problem known as the 'heart failure pandemic'. To control the pandemic, multifaceted approaches are essential, ranging from prevention of onset to long-term disease management. Especially in patients with moderate to severe heart failure (stages C and D), surgical and catheter-based interventions are prerequisites for saving lives, preserving cardiac function, improving quality of life (QOL), and prognosis. In addition, various new medical technologies for these interventions have been clinically applied and have been shown to be effective against symptoms and improve the QOL and prognosis of patients with heart failure. Furthermore, the concept of interventional heart failure (IHF) therapy, which considers heart recovery and prevention of worsening of heart failure via multidisciplinary treatment using surgical, catheter interventions, and mechanical circulatory support devices, has been proposed worldwide. This review discusses the importance of IHF therapy in heart failure management, recent changes in interventional technologies and strategies for patients with heart failure, and worldwide education attempts for IHF specialists.
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Affiliation(s)
- Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
| | - Shohei Yokota
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
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19
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Koo SK, Dignan R, Lo EYW, Williams C, Xuan W. Evidence-Based Determination of Cut-Off Points for Increased Cardiac-Surgery Mortality Risk With EuroSCORE II and STS: The Best-Performing Risk Scoring Models in a Single-Centre Australian Population. Heart Lung Circ 2021; 31:590-601. [PMID: 34756532 DOI: 10.1016/j.hlc.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Risk scoring models (RSMs) are commonly used for estimation of postoperative-mortality risk in patients undergoing cardiac surgery, but their prediction accuracy may vary in different populations and clinical situations. The prognostic accuracies of some RSMs have not yet been fully evaluated in the Australian population. In this retrospective observational study, our aims were to assess the performance of four contemporary RSMs, to identify the best RSMs for prediction of postoperative-mortality in the single-centre cohort, and to determine a statistical threshold for classification of patients with increased or "higher" mortality risk. METHODS The study population included patients who underwent cardiac surgery at Liverpool Hospital between January 2013 and December 2014. Demographic information was collected, and mortality risks were estimated with the ES2 (EuroSCORE II), STS (Society of Thoracic Surgeons Score), AS (AusSCORE total) and ASMR (AusSCORE multi-risk) RSMs. (Additive EuroSCORE) (AES) and LES (logistic EuroSCORE) were included for historical interest. Discrimination, the ability to stratify patients between mortality and no mortality outcomes, and calibration, the comparison of risk score estimated and observed outcome in the population, were evaluated for each RSM, to determine their predictive accuracy in the study population. Discrimination was assessed by the AUC (area under the receiver operating characteristic curve), and acceptable calibration by the p-value greater than 0.05 for the Hosmer-Lemeshow (H-L) test. The best AUCs in contempory models were compared using the DeLong test. For ES2 and STS risk scores, cut-off points, or thresholds, for patients at increased risk of mortality were derived using Youden's J-statistics, calculated from sensitivity and specificity of models in predicting mortality. RESULTS From a total study population of 898 patients, 738 had scores for all six RSMs. The three EuroSCORE risk models and Youden's J-statistics analysis included the total population. Of the models in contemporary use, ES2 had higher discrimination (AUC=0.850) in this population than ASMR (AUC=0.767, p=0.024) and AS (AUC=0.739) and non-significantly higher discrimination than STS (AUC=0.806, p=0.19). All contemporary models had acceptable calibration but the older LES (H-L p=0.024) did not. Estimated mortality was closest to observed mortality with the ES2 model. Both AES and LES over predicted mortality. The RSM with the highest discrimination in isolated coronary artery bypass graft surgery (CAGs) (AUC=0.847), isolated valves (AUC=0.830), and females (AUC=0.784) was the ES2 model. STS discrimination was highest in CAGs plus valve procedures (AUC 0.891), and males (STS AUC=0.891). Cut-off points for risk scores to define increased risk populations were 3.0% for ES2 and 1.7% for STS. Similar proportions of patients in each RSM (ES2-26% to STS-32%) were defined as higher risk by the model threshold score depending on type of procedure. CONCLUSION Among RSMs in contemporary use, ES2 and STS showed the best discrimination and acceptable calibration. Caution is recommended in specific subgroups. Increased mortality risk score cut-off points could be identified for these two RSMs in this single-centre cohort.
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Affiliation(s)
- S K Koo
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - R Dignan
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, NSW, Australia.
| | - E Y W Lo
- Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, NSW, Australia
| | - C Williams
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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20
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Ma H, Lin S, Li X, Dou K, Yang W, Feng W, Liu S, Wu Y, Peng B, Zheng Z. Exploring optimal heart team protocol to improve decision-making stability for complex coronary artery disease: a sequential explanatory mixed method study. Eur Heart J Qual Care Clin Outcomes 2021; 8:739-749. [PMID: 34634101 DOI: 10.1093/ehjqcco/qcab074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/12/2022]
Abstract
AIMS Current guidelines recommend a heart team in the decision making for patients with complex coronary artery disease (CAD). However, the decision-making stability of these teams has not been evaluated and the optimum protocol is unknown. We assessed inter-team agreement for revascularization decision-making and influencing factors to inform the development of a heart team protocol. METHODS AND RESULTS This sequential, explanatory mixed methods study included (1) a cross-sectional quantitative study to assess inter-team agreement on treatment strategy for retrospectively enrolled complex CAD patients and (2) a qualitative study that used semi-structured interviews with heart team members to identify factors influencing decision-making discrepancy. We randomly selected 101 complex CAD patients. Sixteen specialists were randomly assigned to 4 heart teams to make decisions for these patients. The primary outcome kappa of inter-team decision-making agreement was moderate (kappa 0.58). Factors influencing decision-making were generated through inductive thematic analysis and were summarized by 3 themes (specialist quality, team composition, meeting process) and 10 subthemes. Recommendations of heart team implementation were generated based on qualitative and quantitative data at 5 levels: specialist selection, specialist training, team composition, team training, and meeting process. A detailed protocol on the integration of guidelines, previous experience and recommendations was generated to establish and deploy a qualified heart team. CONCLUSIONS Agreement between heart teams for revascularization decision-making in complex CAD patients was moderate. Potential factors associated with decision discrepancies were summarized and recommendations were generated. A detailed heart team protocol was designed and should be validated in future.
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Affiliation(s)
- Hanping Ma
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kefei Dou
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Weixian Yang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Feng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Sheng Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Wu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Boshizhang Peng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
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21
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Nettersheim FS, Baldus S. [ESC/EACTS guidelines 2021 on the management of valvular heart diseases : What are the most important innovations?]. Herz 2021. [PMID: 34609559 DOI: 10.1007/s00059-021-05068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
In August 2021 the European Society for Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) updated their guidelines on the management of valvular heart disease. Since the publication of the previous version in 2017 new evidence regarding epidemiology, diagnosis and treatment of valvular heart diseases has been accumulating, which led to reassessment of several recommendations. Most importantly, the critical role of the heart team in treatment decision-making was reemphasized, the criteria for choosing the mode of aortic valve interventions were clarified, the definition of severe secondary mitral regurgitation was revised and the recommendation for transcatheter edge-to-edge mitral valve repair in patients with this condition was upgraded. Additionally, antithrombotic therapeutic regimens in patients with native valvular heart diseases and bioprostheses were reappraised, the indications for early surgery in selected asymptomatic patient groups were expanded and the potential of transcatheter tricuspid valve interventions in inoperable and high-risk patients was acknowledged, although the latter needs to be further evaluated. This review article summarizes the most important recommendations of the new guidelines.
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22
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Chambers JB. Specialists give better care than generalists for mitral valve disease. Eur J Cardiothorac Surg 2021; 60:274-275. [PMID: 34021324 DOI: 10.1093/ejcts/ezab103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- John B Chambers
- Cardiothoracic Centre, Guy's and St Thomas' Hospitals, London, UK
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23
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. Eur J Cardiothorac Surg 2021; 59:522-531. [PMID: 33459337 DOI: 10.1093/ejcts/ezaa402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discusses strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Catania, Italy
| | - Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Sardari Nia P, Olsthoorn JR, Heuts S, van Kuijk SMJ, Vainer J, Streukens S, Schalla S, Segers P, Barenbrug P, Crijns HJGM, Maessen JG. Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data. Eur J Cardiothorac Surg 2021; 60:263-273. [PMID: 33783480 DOI: 10.1093/ejcts/ezab065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Although in both the US and European guidelines the 'heart team approach' is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009-2014) and a dedicated mitral valve heart team (2014-2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68-0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66-0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54-0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25-0.62; P < 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37-0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.
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Affiliation(s)
- Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Jindrich Vainer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sebastian Streukens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Paul Barenbrug
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Harry J G M Crijns
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
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25
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Del Forno B, Ascione G, De Bonis M. Advances in Mitral Valve Repair for Degenerative Mitral Regurgitation: Philosophy, Technical Details, and Long-Term Results. Cardiol Clin 2021; 39:175-184. [PMID: 33894931 DOI: 10.1016/j.ccl.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Degenerative mitral valve disease represents the most common cause of mitral regurgitation in industrialized countries. When left untreated, patients with severe degenerative mitral regurgitation show a poor clinical outcome. Conversely, a timely and appropriate correction provides a restored life expectancy and a good quality of life. Therefore, in this scenario, surgical mitral valve repair represents the gold standard of treatment. This review aims to analyze the indications, timing, and contemporary surgical techniques of mitral valve repair for degenerative mitral regurgitation. Moreover, the value of heart team approach and centers of excellence for mitral valve repair are also deeply discussed.
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Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
| | - Guido Ascione
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
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26
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Lamm G, Hammerer M, Hoppe UC, Andreas M, Berger R, Binder RK, Bonaros N, Delle-Karth G, Frick M, Grund M, Metzler B, Neunteufl T, Pichler P, Schmidt A, Wisser W, Zierer A, Seitelberger R, Grimm M, Geppert A; ÖKG and ÖGHTG. 2020 update of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGHTG) on the position statement of the ÖKG and ÖGHTG for transcatheter aortic valve implantation 2011. Wien Klin Wochenschr 2021; 133:750-61. [PMID: 33755758 DOI: 10.1007/s00508-021-01820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
This position statement is an update to the 2011 consensus statement of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGTHG) for transfemoral transcatheter aortic valve implantation.Due to a number of recently published studies, broadening of indications and recommendations of medical societies and our own national developments, the ÖKG and the ÖGHTG wish to combine the 2017 ESC/EACTS guidelines for the management of valvular heart disease with a national position paper and to focus on certain details for the application in Austria. Thus, this position statement serves as a supplement and further interpretation of the international guidelines.
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27
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. Eur Heart J Acute Cardiovasc Care 2021; 10:83-93. [PMID: 33721018 DOI: 10.1093/ehjacc/zuaa013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discuss strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Italy
| | - Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, 2790-134 Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern 3010, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clincal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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28
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Abstract
For all patients with cardiovascular disease requiring an intervention, this is a major life event. The heart team concept is one of the most exciting and effective team modalities to ensure cost-effective application of invasive cardiovascular care. It optimises patient selection in a complex decision-making process and identifies risk/benefit ratios of different interventions. Informed consent and patient safety should be at the centre of these decisions. To deal with increased load of medical data in the future, artificial intelligence could enable objective and effective interpretation of medical imaging and decision support. This technical support is indispensable to meet current patient and societal demands for informed consent, shared decision-making, outcome improvement and safety. The heart team should be restructured with clear leadership, accountability, and process and outcome measurement of interventions. In this way, the heart team concept in the Netherlands will be ready for the future.
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Affiliation(s)
- E Wierda
- Department of Cardiology, Dijklander Hospital, location Hoorn, Hoorn, The Netherlands.
| | - D van Veghel
- Department of Cardiology and Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - A Hirsch
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B A J M de Mol
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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29
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Coisne A, Pontana F, Aghezzaf S, Mouton S, Ridon H, Richardson M, Polge AS, Longère B, Silvestri V, Pagniez J, Bical A, Rousse N, Overtchouk P, Granada JF, Hahn RT, Modine T, Montaigne D. Utility of Three-Dimensional Transesophageal Echocardiography for Mitral Annular Sizing in Transcatheter Mitral Valve Replacement Procedures: A Cardiac Computed Tomographic Comparative Study. J Am Soc Echocardiogr 2020; 33:1245-1252.e2. [PMID: 32718722 DOI: 10.1016/j.echo.2020.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Three-dimensional (3D) transesophageal echocardiographic (TEE) imaging is frequently used as an initial screening tool in the evaluation of patients who are candidates for transcatheter mitral valve replacement (TMVR). However, little is known about the imaging correlation with the gold standard, computed tomographic (CT) imaging. The aims of this study were to test the quantitative differences between these two modalities and to determine the best 3D TEE parameters for TMVR screening. METHODS Fifty-seven patients referred to the heart valve clinic for TMVR with prostheses specifically designed for the mitral valve were included. Mitral annular (MA) analyses were performed using commercially available software on 3D TEE and CT imaging. RESULTS Three-dimensional TEE imaging was feasible in 52 patients (91%). Although 3D TEE measurements were slightly lower than those obtained on CT imaging, measurements of both projected MA area and perimeter showed excellent correlations, with small differences between the two modalities (r = 0.88 and r = 0.92, respectively, P < .0001). Correlations were significant but lower for MA diameters (r = 0.68-0.72, P < .0001) and mitroaortic angle (r = 0.53, P = .0001). Receiver operating characteristic curve analyses showed that 3D TEE imaging had a good ability to predict TMVR screening success, defined by constructors on the basis of CT measurements, with ranges of 12.9 to 15 cm2 for MA area (area under the curve [AUC] = 0.88-0.91, P < .0001), 128 to 139 mm for MA perimeter (AUC = 0.85-0.91, P < .0001), 35 to 39 mm for anteroposterior diameter (AUC = 0.79-0.84, P < .0001), and 37 to 42 mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, P < .0001). CONCLUSIONS Three-dimensional TEE measurements of MA dimensions display strong correlations with CT measurements in patients undergoing TMVR screening. Three-dimensional TEE imaging should be proposed as a reasonable alternative to CT imaging in this vulnerable population.
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Affiliation(s)
- Augustin Coisne
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France; Université de Lille, U1011 - EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France.
| | - François Pontana
- Université de Lille, U1011 - EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France; Department of Cardiovascular Radiology, CHU Lille, Lille, France
| | - Samy Aghezzaf
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France
| | - Stéphanie Mouton
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France
| | - Hélène Ridon
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France
| | - Marjorie Richardson
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France
| | - Anne-Sophie Polge
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France
| | - Benjamin Longère
- Department of Cardiovascular Radiology, CHU Lille, Lille, France
| | | | - Julien Pagniez
- Department of Cardiovascular Radiology, CHU Lille, Lille, France
| | - Antoine Bical
- Department of Cardiovascular Surgery, CHU Lille, Lille, France
| | - Natacha Rousse
- Department of Cardiovascular Surgery, CHU Lille, Lille, France
| | | | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Thomas Modine
- Department of Cardiovascular Surgery, CHU Lille, Lille, France
| | - David Montaigne
- Department of Clinical Physiology and Echocardiography - Heart Valve Center, CHU Lille, Lille, France; Université de Lille, U1011 - EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
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30
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Gallone G, Landra F, D'Ascenzo F, Conrotto F, Casoni R, Bruno F, Omedè P, Alunni G, Andreis A, Vairo A, Giorgi M, Fava A, De Ferrari GM. In the midst of a dangerous intersection with unclear therapeutic strategies: a challenging case of severe aortic stenosis. BMC Cardiovasc Disord 2020; 20:261. [PMID: 32487051 PMCID: PMC7268312 DOI: 10.1186/s12872-020-01533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background One out of seven patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) may be affected by transthyretin cardiac amyloidosis (ATTR-CA), mostly presenting with low-flow low-gradient AS with mildly reduced ejection fraction. The complex interaction of these two pathologies poses specific diagnostic and management challenges. The prognostic implications of this clinical intersection are not defined yet. Moreover, whether TAVR may have a prognostic benefit in ATTR-CA patients with symptomatic severe AS remains unclear, posing doubts on the best management strategy in this increasingly recognized subset of patients. Clinical case We present a case of an 87-year old man with low-flow low-gradient severe AS, for whom a diagnosis of ATTR-CA was suspected based on clinical and echocardiographic criteria specific to coexisting AS and ATTR-CA. The diagnosis was eventually confirmed by positive bone tracer scintigraphy imaging. Following in-depth Heart team discussion, integrating frailty and prognostic information from combined cardiomyopathy states, a decision was made to manage the patient’s severe AS conservatively. Conclusion In the presented case, we deemed the natural history of ATTR-CA amyloidosis to negatively affect both the patient’ prognosis and procedural risk, adversing TAVR indication despite symptomatic severe AS. No clear evidence is currently available to guide decision making in this setting, advocating for prospective studies to clarify if TAVR may have a prognostic benefit in ATTR-CA - and which ATTR-CA - patients.
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Affiliation(s)
- Guglielmo Gallone
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Federico Landra
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy.,Division of Cardiology, Città della Salute e della Scienza, Corso Bramante 88/90, 10126, Turin, Italy
| | - Federico Conrotto
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - Roberta Casoni
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Bruno
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Omedè
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gianluca Alunni
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alessandro Andreis
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alessandro Vairo
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mauro Giorgi
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Antonella Fava
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
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Boeder NF, Bayer M, Niemann B, Nef HM. First-in-Man Lithoplasty of a LIMA Bypass With ECMO Support in a Last-Remaining Vessel. Cardiovasc Revasc Med 2020; 21:155-157. [PMID: 32423793 DOI: 10.1016/j.carrev.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
We report the case of a 70-year-old patient with history of chronic heart disease who underwent bypass surgery twice beforehand and was admitted due to non-ST segment elevation myocardial infarction. Angiography showed degeneration of all bypass grafts except the LIMA bypass, which showed significant ostial stenosis with severe calcification. Peri-operative risk was computed to be as high as 12.3% (STS Score). An interventional strategy was chosen: the very high-risk procedure was performed safely under the protection afforded by venoarterial ECMO and cardiac surgeons on standby using a coronary intravascular lithoplasty (IVL) balloon. After implantation of a drug eluting stent, the primary angiogram showed a satisfactory result. The patient was discharged without further complications short after the procedure and is closely followed-up.
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Affiliation(s)
- Niklas F Boeder
- Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Matthias Bayer
- Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Bernd Niemann
- Department of Cardiovascular Heart Surgery, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany
| | - Holger M Nef
- Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
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de Jaegere PPT, de Weger A, den Heijer P, Verkroost M, Baan J, de Kroon T, America Y, Brandon Bravo Bruinsma GJ. Treatment decision for transcatheter aortic valve implantation: the role of the heart team : Position statement paper of the Dutch Working Group of Transcatheter Heart Interventions. Neth Heart J 2020; 28:229-239. [PMID: 31981094 PMCID: PMC7190764 DOI: 10.1007/s12471-020-01367-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The current paper presents a position statement of the Dutch Working Group of Transcatheter Heart Valve Interventions that describes which patients with aortic stenosis should be considered for transcatheter aortic valve implantation and how this treatment proposal/decision should be made. Given the complexity of the disease and the assessment of its severity, in particular in combination with the continuous emergence of new clinical insights and evidence from physiological and randomised clinical studies plus the introduction of novel innovative treatment modalities, the gatekeeper of the treatment proposal/decision and, thus, of qualification for cost reimbursement is the heart team, which consists of dedicated professionals working in specialised centres.
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Affiliation(s)
- P P T de Jaegere
- Department of Cardiology, Erasmus University, Rotterdam, The Netherlands.
| | - A de Weger
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, University Hospital Nijmegen, Nijmegen, The Netherlands
| | - J Baan
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - T de Kroon
- Department of Cardiothoracic Surgery, Antonius Ziekenhuis Nieuwegein, Nieuwegein, The Netherlands
| | - Y America
- Department of Cardiology, Rijnstate Ziekenhuis Arnhem, Arnhem, The Netherlands
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Fabris E, De Luca A, Vitrella G, Stolfo D, Masè M, Korcova R, Merlo M, Rakar S, Van't Hof AWJ, Kedhi E, Perkan A, Sinagra G. Treatment of Functional Mitral Regurgitation in Heart Failure. Curr Cardiol Rep 2019; 21:139. [PMID: 31734930 DOI: 10.1007/s11886-019-1221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. RECENT FINDINGS The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy.
| | - Antonio De Luca
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Giancarlo Vitrella
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Masè
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Serena Rakar
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Arnoud W J Van't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Andrea Perkan
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
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Cayla G, Schmutz L, Soullier C, Ricci JE, Robert C, Cambon-Viala M, Goger AL, Lattuca B. [Which patient for TAVI in 2019?]. Ann Cardiol Angeiol (Paris) 2019; 68:405-409. [PMID: 31668846 DOI: 10.1016/j.ancard.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
The therapeutic management of aortic stenosis has been drastically changed by the advent of percutaneous valve replacement (TAVI). Since the first implantation, the indications have progressively been extended from the inoperable patient to the patient at low surgical risk. The main objective of this review is to describe the currently recommended main indications of TAVI depending on an individualized assessment of each patient's risk, technical characteristics and anatomical valvular criteria.
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Affiliation(s)
- G Cayla
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France.
| | - L Schmutz
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - C Soullier
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - J E Ricci
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - C Robert
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - M Cambon-Viala
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - A L Goger
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
| | - B Lattuca
- Service de cardiologie, université de Montpellier, CHU de Nîmes, 30029 Nîmes, France
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Kam D, Patel PA, Steinberg T, Feinman JW, MacKay EJ, Patel S, Mickus GJ, Fabbro M, Augoustides JGT. Percutaneous Edge-to-Edge Mitral Valve Repair: Navigating the Challenges of Multiple Mechanisms for Mitral Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:2327-2333. [PMID: 31079894 DOI: 10.1053/j.jvca.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- David Kam
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Toby Steinberg
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory J Mickus
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Rea CW, Wang TKM, Ruygrok PN, Sidhu K, Ramanathan T, Nand P, Stewart JT, Webster MWI. Characteristics and Outcomes of Patients With Severe Aortic Stenosis Discussed by the Multidisciplinary " Heart Team" According to Treatment Allocation. Heart Lung Circ 2019; 29:368-373. [PMID: 30948328 DOI: 10.1016/j.hlc.2019.02.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/30/2018] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an alternative and effective contemporary intervention to surgical aortic valve replacement (SAVR) for patients with severe aortic valve disease at increased surgical risk. Guidelines recommend a multidisciplinary "Heart Team" (MHT) review of patients considered for a TAVI procedure, but this has been little studied. We reviewed the characteristics, treatments and outcomes of such patients reviewed by the MHT at our centre. METHODS Data on consecutive patients with severe aortic valve stenosis discussed by the Auckland City Hospital MHT from June 2011 to August 2016 were obtained from clinical records. Patient characteristics, treatment and outcomes were analysed using standard statistical methods. RESULTS Over the 5-year period 243 patients (mean age 80.2 ± 8.0 years, 60% male) were presented at the MHT meeting. TAVI was recommended for 200, SAVR for 26 and medical therapy for 17 patients, with no significant difference in mean age (80.2 ± 8.3, 80.4 ± 6.1, 80.4 ± 7.3 years, respectively) or EuroSCORE II (6.5 ± 4.7%, 5.3 ± 3.6%, 6.7 ± 4.3%, respectively). Over time, there was an increase in the number of patients discussed and treated, with no change in their mean age, but the mean EuroSCORE II significantly decreased (TAVI p = 0.026, SAVR p = 0.004). Survival after TAVI and SAVR was similar to that of the age-matched general population, but superior to medical therapy p = 0.002 (93% (n = 162), 84% (n = 21) and 73% (n = 18) at one year and 85% (n = 149), 84% (n = 21) and 54% (n = 13) at 2 years, respectively). CONCLUSIONS An increasing number of patients were discussed at the MHT meeting with the majority undergoing TAVI, with a similar age and EuroSCORE II to those allocated SAVR or medical therapy. Survival following TAVI and SAVR was superior to medical therapy and similar to the age-matched general population. These findings suggest that the MHT process is robust, consistent and appropriately allocating a limited treatment resource.
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Affiliation(s)
- Conor W Rea
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Tom Kai Ming Wang
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Peter N Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
| | - Karishma Sidhu
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Parma Nand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - James T Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Mark W I Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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38
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Heuts S, Olsthoorn JR, Hermans SMM, Streukens SAF, Vainer J, Cheriex EC, Segers P, Maessen JG, Sardari Nia P. Multidisciplinary decision-making in mitral valve disease: the mitral valve heart team. Neth Heart J 2019; 27:176-184. [PMID: 30742250 PMCID: PMC6439106 DOI: 10.1007/s12471-019-1238-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Although decision-making using the heart-team approach is apparently intuitive and has a class I recommendation in most recent guidelines, supportive data is still lacking. The current study aims to demonstrate the individualised clinical pathway for mitral valve disease patients and to evaluate the outcome of all patients referred to the dedicated mitral valve heart team. Methods All patients who were evaluated for mitral valve pathology with or without concomitant cardiac disease between 1 January 2016 and 31 December 2016 were prospectively followed and included. Patients were evaluated, and a treatment strategy was determined by the dedicated mitral valve heart team. Results One hundred and fifty-eight patients were included; 67 patients were treated surgically (isolated and concomitant surgery), 20 by transcatheter interventions and 71 conservatively. Surgically treated patients had a higher 30-day mortality rate (4.4%), which decreased when specified to a dedicated surgeon (1.7%) and in primary, elective cases (0%). This was also observed for major adverse events within 30 days. Residual mitral regurgitation >grade 2 was more frequent in the catheter-based intervention group (23.5%) compared to the surgical group (4.8%). Conclusion In conclusion, the implementation of a multidisciplinary heart team for mitral valve disease is a valuable approach for the selection of patients for different treatment modalities. Our research group will focus on a future comparative study using historical cohorts to prove the potential superiority of the dedicated multidisciplinary heart-team approach.
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Affiliation(s)
- S Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S M M Hermans
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S A F Streukens
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Vainer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E C Cheriex
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - P Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
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Sarkar K. Heart Team-the Indian perspective. Indian J Thorac Cardiovasc Surg 2018; 34:355-361. [PMID: 33060959 PMCID: PMC7525544 DOI: 10.1007/s12055-018-0764-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery as well as the American College of Cardiology and the American Heart association have recognized the “Heart Team” as the best option for a patient centric treatment strategy and has granted a class I recommendation for its formation. The aim of this review is to discuss the evolution, scope and composition, the benefits, and problems inherent in its implementation in the Indian scenario. Methods A review of articles on Heart Team from cardiac surgery as well as multidisciplinary meetings from other specialties was performed. Advantages of Heart Team formation and its implementation have been critically evaluated and its applicability to the Indian scenario considered in particular. Results Heart Team formation is associated with many positives. Concern remains about the implementation of Heart Team approach in its true sense. Heart Team-led decisions are definitely patient centric despite multiple challenges in resource-limited environments. Conclusions Despite the challenges, a multidisciplinary team approach in the form of Heart Team is recommended and its implementation possible in India. However, adjustments to the mechanism of implementation are required. Further research needs to focus on creating models for implementation and assessment of these models in terms of cost effectiveness, improved patient outcomes, and patient satisfaction in the process.
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Affiliation(s)
- Kunal Sarkar
- Department of Cardiac Surgery, Medica Superspecialty Hospital, Kolkata, India
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40
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Droppa M, Borst O, Katzenberger T, Krause R, Bramlage K, Bramlage P, Lausberg HF, Schlensak C, Grasshoff C, Gawaz M, Geisler T. Clinical and economical impact of the presence of an extended heart team throughout the balloon-expandable transcatheter aortic valve implantation procedure. Clin Res Cardiol 2019; 108:315-23. [PMID: 30167808 DOI: 10.1007/s00392-018-1359-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a standard therapy for aortic valve stenosis in patients at intermediate-to-high surgical risk. Previously, TAVI at our site was performed by a minimalist heart team (MHT), comprised of two interventional cardiologists, echocardiography staff and two cardiac catheterization laboratory nurses. After revision of German Federal Joint Committee (G-BA) guidelines in September 2015, the presence of an extended heart team (EHT; including a full cardiac surgical team) became mandatory throughout the TAVI procedure. We aimed to evaluate the impact of the EHT on clinical and economical outcomes. METHODS Data was retrospectively extracted from the medical records of patients receiving an Edwards SAPIEN 3 valve at the University Hospital Tübingen, Germany, between 2014 and 2017 and matched with cost data from the national invoice system of hospitals (InEK). For comparison, patients were grouped according to whether they underwent TAVI with or without the EHT. RESULTS Overall, data for 341 patients (MHT 233; EHT 118) were analysed. Baseline characteristics were largely similar between groups (mean age 81.0 years; 54.5% female), though EHT patients had a lower mean logEuroSCORE (17.5% vs. 19.8%; p = 0.011) and more prior PCI/stenting (39.0% vs. 26.9%; p = 0.022). The rate of immediate procedural death (1.7%) was comparable between groups, as was mortality at 30 days (4.2%). Overall, 1.2% of patients required conversion to surgery. The cost of the index hospitalisation (minus the prosthesis) was higher in the EHT condition (difference + €1604), largely driven by expenditure on physicians (difference + €581; p < 0.001), medical technicians (difference + €372; p < 0.001) and medical supplies (difference +€244; p = 0.001). CONCLUSION At our site, the presence of an EHT throughout the TAVI procedure appears to substantially increase hospital expenditure without significantly improving patient outcomes. We suggest that TAVI by a minimalist HT with a surgical team on call in case of emergency may be sufficient.
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Fellahi JL, Godier A, Benchetrit D, Berthier F, Besch G, Bochaton T, Bonnefoy-Cudraz E, Coriat P, Gayat E, Hong A, Jenck S, Le Gall A, Longrois D, Martin AC, Pili-Floury S, Piriou V, Provenchère S, Rozec B, Samain E, Schweizer R, Billard V. Perioperative management of patients with coronary artery disease undergoing non-cardiac surgery: Summary from the French Society of Anaesthesia and Intensive Care Medicine 2017 convention. Anaesth Crit Care Pain Med 2018; 37:367-374. [PMID: 29567130 DOI: 10.1016/j.accpm.2018.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/09/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
This review summarises the specific stakes of preoperative, intraoperative, and postoperative periods of patients with coronary artery disease undergoing non-cardiac surgery. All practitioners involved in the perioperative management of such high cardiac risk patients should be aware of the modern concepts expected to decrease major adverse cardiac events and improve short- and long-term outcomes. A multidisciplinary approach via a functional heart team including anaesthesiologists, cardiologists and surgeons must be encouraged. Rational and algorithm-guided management of those patients should be known and implemented from preoperative to postoperative period.
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Affiliation(s)
- Jean-Luc Fellahi
- Department of anaesthesia and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
| | - Anne Godier
- Department of anaesthesia and intensive care, fondation Adolphe-de-Rothschild, 75019 Paris, France
| | - Deborah Benchetrit
- Department of anaesthesia and intensive care, Pitié-Salpêtrière university hospital, Paris, France
| | - Francis Berthier
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Guillaume Besch
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Thomas Bochaton
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Eric Bonnefoy-Cudraz
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Pierre Coriat
- Department of anaesthesia and intensive care, Pitié-Salpêtrière university hospital, Paris, France
| | - Etienne Gayat
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Alex Hong
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Sophie Jenck
- Intensive care and cardiological emergencies, Louis-Pradel hospital, hospices civils de Lyon, Lyon, France
| | - Arthur Le Gall
- Department of anaesthesia ans intensive care, Saint-Louis-Lariboisière-Fernand-Widal university hospitals, Paris, France
| | - Dan Longrois
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard hospital, Paris, France
| | | | - Sébastien Pili-Floury
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Vincent Piriou
- Department of anaesthesia and intensive care, hospices civils de Lyon, Lyon-sud hospital, Lyon, France
| | - Sophie Provenchère
- Department of anaesthesia and intensive care, Bichat-Claude-Bernard hospital, Paris, France
| | - Bertrand Rozec
- Department of anaesthesia and intensive care, Nantes university hospital, Nantes, France
| | - Emmanuel Samain
- Department of anaesthesia and intensive care, Besançon university hospital, Besançon, France
| | - Rémi Schweizer
- Department of anaesthesia and intensive care, Louis-Pradel hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - Valérie Billard
- Department of anaesthesia, institut Gustave-Roussy, Villejuif, France
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Costa C, Teles RC, Brito J, Neves JP, Gabriel HM, Abecassis M, Ribeiras R, Abecasis J, Nolasco T, Furstenau MDC, Vale N, Tralhão A, Madeira S, Mesquita J, Saraiva C, Calé R, Almeida M, Aleixo A, Mendes M. Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience. Rev Port Cardiol 2017; 36:809-818. [PMID: 29153618 DOI: 10.1016/j.repc.2016.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/09/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. METHODS The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. RESULTS TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients' outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). CONCLUSIONS The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner.
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Affiliation(s)
- Cátia Costa
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Santarém, Santarém, Portugal.
| | - Rui Campante Teles
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - João Brito
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - José Pedro Neves
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | | | - Miguel Abecassis
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Regina Ribeiras
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - João Abecasis
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - Tiago Nolasco
- Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | | | - Nélson Vale
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - António Tralhão
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Sérgio Madeira
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - João Mesquita
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
| | - Carla Saraiva
- Serviço de Imagiologia, Hospital S. Francisco Xavier (CHLO), Lisboa, Portugal
| | - Rita Calé
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Garcia Orta, Almada, Portugal
| | - Manuel Almeida
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal
| | - Ana Aleixo
- CEDOC, Nova Medical School, Lisboa, Portugal
| | - Miguel Mendes
- Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal
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43
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Abstract
Cardiogenic shock remains one of the most common causes of in-hospital death. Recent data have identified an overall increase in patient complexity, with cardiogenic shock in the setting of acute myocardial infarction. The use of percutaneous acute mechanical circulatory support (AMCS) has steadily grown in the past decade. Guidelines and consensus statements addressing proper patient selection, timing of AMCS implantation, device choice, and postimplantation protocol are appearing. The emerging role of interventional heart failure specialists within the heart team includes integration and understanding of advanced hemodynamic and cathether-based therapies, with the goal of improving outcomes.
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Affiliation(s)
- Navin K Kapur
- The Acute Mechanical Support Working Group, The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
| | - Carlos D Davila
- The Acute Mechanical Support Working Group, The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Marwan F Jumean
- Center for Advanced Heart Failure, University of Texas Health Medical School, 6400 Fannin Street, Houston, TX 77030, USA
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44
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Saia F, Moretti C, Dall'Ara G, Ciuca C, Taglieri N, Berardini A, Gallo P, Cannizzo M, Chiarabelli M, Ramponi N, Taffani L, Bacchi-Reggiani ML, Marrozzini C, Rapezzi C, Marzocchi A. Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making. J Geriatr Cardiol 2016; 13:475-82. [PMID: 27582761 DOI: 10.11909/j.issn.1671-5411.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade ≥ 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23.5% ± 15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% (0.5% major; 3.5% minor). Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment (25.4% for AVR; 47.2% for TAVI): 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.
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45
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Vogt F, Wicklein S, Singler K, Pfeiffer S, Fischlein T, Schwab J, Pauschinger M, Jessl J. [Aortic valve replacement in the elderly]. Z Gerontol Geriatr 2016; 49:639-56. [PMID: 27518151 DOI: 10.1007/s00391-016-1112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/27/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
Abstract
The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome. Various methods of geriatric assessment are important supplements to standard risk scores. The aim is to implement targeted interventions to minimize the risk factors and to improve the prognosis for elderly patients. The aim of this article is to provide an overview of the current therapy options for aortic valve replacement and to summarize current aspects of treatment options for elderly patients.
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46
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Saji M, Hoyt WJ Jr, Ailawadi G, Mulloy DP, Ghanta RK, Ragosta M, Scott Lim D. Transcatheter Aortic Valve Replacement in a Young Adult Patient with a Failed Homograft. Pediatr Cardiol 2016; 37:986-8. [PMID: 27084384 DOI: 10.1007/s00246-016-1399-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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47
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Abstract
Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.
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Affiliation(s)
- Neil Ruparelia
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK
| | - Alaide Chieffo
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
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48
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Abstract
The method of revascularization for multi-vessel coronary artery disease (MVD) has traditionally been coronary artery bypass grafting (CABG), however, due to recent advances in the field of percutaneous coronary intervention (PCI), this latter technique has gained in popularity and its role in guidelines has been promoted. This review aims to address the current data available for the treatment of patients with complex coronary disease, including the specific disease subset in those with diabetes mellitus, focusing on the importance of risk stratification and review by the 'Heart Team'. The concept of complete versus incomplete revascularization and the assessment of lesions utilizing functional techniques are discussed. Over recent years, PCI has grown to become the most frequently performed therapeutic intervention in medicine and continues to grow. There are encouraging data that this is an effective and safe treatment option in selected patients, however, neither strategy alone can provide a solution for the entire spectrum of patients with MVD.
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Affiliation(s)
- Gill Louise Buchanan
- Department of Cardiology, North Cumbria University NHS Trust, Carlisle, United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Hospital, Milan, Italy.
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49
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Abstract
Fusion of different imaging modalities has gained increasing popularity over the last decade. However, most fusions are done between static rather than dynamic images. In order to adequately visualize the complex three-dimensional structures of the beating heart, high-temporal and spatial image resolutions are mandatory. Currently, only the combination of transesophageal echocardiography with fluoroscopy allows real-time image fusion of high quality during structural heart disease (SHD) interventions. The use of markers as well as real-time image overlay greatly facilitates communication between SHD team members and potentially increases procedural success while reducing radiation dose and use of contrast. However, to date there is only limited evidence that fusion imaging improves safety and outcomes of SHD interventions. This review highlights the benefits of fusion imaging during SHD interventions such as transseptal puncture and closure of atrial septal defects and left atrial appendage as well as interventions on the mitral and aortic valve.
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Affiliation(s)
- Patric Biaggi
- />Heart Clinic Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland
| | | | - Rebecca Hahn
- />Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY 10032 USA
| | - Roberto Corti
- />Heart Clinic Zurich, Witellikerstrasse 40, 8032 Zurich, Switzerland
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50
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Head SJ, Börgermann J, Osnabrugge RLJ, Kieser TM, Falk V, Taggart DP, Puskas JD, Gummert JF, Kappetein AP. Coronary artery bypass grafting: Part 2--optimizing outcomes and future prospects. Eur Heart J 2014; 34:2873-86. [PMID: 24086086 DOI: 10.1093/eurheartj/eht284] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since first introduced in the mid-1960s, coronary artery bypass grafting (CABG) has become the standard of care for patients with coronary artery disease. Surprisingly, the fundamental surgical technique itself did not change much over time. Nevertheless, outcomes after CABG have dramatically improved over the first 50 years. Randomized trials comparing percutaneous coronary intervention (PCI) to CABG have shown converging outcomes for select patient populations, providing more evidence for wider use of PCI. It is increasingly important to focus on the optimization of the short- and long-term outcomes of CABG and to reduce the level of invasiveness of this procedure. This review provides an overview on how new techniques and widespread consideration of evolving strategies have the potential to optimize outcomes after CABG. Such developments include off-pump CABG, clampless/anaortic CABG, minimally invasive CABG with or without extending to hybrid procedures, arterial revascularization, endoscopic vein harvesting, intraprocedural epiaortic scanning, graft flow assessment, and improved secondary prevention measures. In addition, this review represents a framework for future studies by summarizing the areas that need more rigorous clinical (randomized) evaluation.
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Affiliation(s)
- Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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