MD Conference Express AHA 2011 - (Page 22)

n S E L E C T E D U P D A T E S I N V A LV U L A R D I S E A S E Valvular Heart Disease – From Clinic to Catheter Strategies Written by Rita Buckley Assessing Risk Blase A. Carabello, MD, Baylor College of Medicine, Houston, Texas, USA, discussed variables that put patients who are undergoing aortic valve replacement at increased risk (eg, coronary heart disease, renal failure, liver and lung disease, and porcelain aorta); the impact of these factors on morbidity and mortality; and the validity of standardized risk algorithms. The European System for Cardiac Operative Evaluation (EuroSCORE) [http://www. euroscore.org/] and the Society of Thoracic Surgeons (STS) score [http://www.sts.org/ quality-research-patient-safety/quality/quality-performance-measures] [Roqes F et al. Eur Heart J 2003; Edwards FH et al. Ann Thorac Surg 1997] are used widely for the evaluation of procedural risk in cardiac surgery [http://209.220.160.181/STSWebRiskCalc261/de.aspx]. Dr. Carabello discussed bias in the STS database (weighted toward coronary artery bypass grafting) and recent modifications in its scoring system for valvular heart disease. Risk factors not only include renal and lung function, number of surgeries, and whether the patient has coronary artery disease but also a host of unmeasured variables, such as frailty, depression, the clinician’s overall impression, and the success rate of the team that is selected to perform the operation. In that noncardiac comorbidities can outweigh risks that are associated with cardiac issues and that all risk is individual, it is in the patient’s best interests to have his or her case reviewed by a joint cardiology-cardiac surgery team to determine which therapy is best for each patient. Aortic Valve Technology Technological advances in aortic valves, delivery systems, and techniques have improved outcomes, reduced length of hospital stays, and confirmed all preclinical expectations in an increasingly broad spectrum of patients. A presentation by Helene Eltchaninoff, MD, Charles Nicolle Hospital, Rouen, France, reviewed aortic valve technology. Dr. Eltchaninoff discussed transcatheter aortic valve implantation (TAVI) valves, delivery systems, and techniques from Edwards Lifesciences since 2004, comparing the company’s earlier SAPIEN™ transfemoral and transapical 23- and 26-mm valves with the RetroFlex delivery system to its SAPIEN XT™, which is currently being used in Europe with improved Novaflex transfemoral and Ascendra 2 transapical delivery systems. There are approximately 500 TAVI centers in Europe and some 50,000 patients worldwide. Expanded clinical indications will be determined by improvements in transcatheter valves and delivery systems, new imaging technologies and embolic protection devices, upcoming registries, controlled trials in specific subsets of patients, and assessment of valve and platform durability. Outcomes of TAVI in high-risk and inoperable patients have been reported in a number of registries and have confirmed the results of the pivotal PARTNER-US Trial. TAVI has recently been approved by the United States Food and Drug Administration for use in nonsurgical patients. Patients must enroll and be followed long term within the new STS/ACC TVT Registry [https://www.ncdr.com/TVT/Home/Default.aspx]. Peer-Reviewed Highlights from the scientificsessions.org my.americanheart.org 22 January 2012 www.mdconferencexpress.com  http://www.mdconferencexpress.com http://www.euroscore.org/ http://www.euroscore.org/ http://www.sts.org/quality-research-patient-safety/quality/quality-performance-measures http://www.sts.org/quality-research-patient-safety/quality/quality-performance-measures http://209.220.160.181/STSWebRiskCalc261/de.aspx http://my.americanheart.org/professional/Sessions/ScientificSessions/Scientific-Sessions_UCM_316900_SubHomePage.jsp http://www.scientificsessions.org https://www.ncdr.com/TVT/Home/Default.aspx http://my.americanheart.org http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express AHA 2011

MD Conference Express AHA 2011

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