Objectives The study undertook a systematic review to establish and compare the risk of stroke between the 2 widely used approaches (transfemoral TF vs. transapical TA) and valve designs (CoreValve, ...Medtronic, Minneapolis, Minnesota vs. Edwards Valve, Edwards Lifesciences, Irvine, California) for transcatheter aortic valve replacement (TAVR). Background There has been a rapid adoption and expansion in the use of TAVR. The technique is however far from perfect and requires further refinement to alleviate safety concerns that include stroke. Methods All studies reporting on the risk of stroke after TAVR were identified using an electronic search and pooled using established meta-analytical guidelines. Results 25 multicenter registries and 33 single-center studies were included in the analysis. There was no difference in pooled 30-day stroke post-TAVR between the TF and TA approach in multicenter (2.8% 95% confidence interval (CI): 2.4 to 3.4 vs. 2.8% 95% CI: 2.0 to 3.9) and single-center studies (3.8% 95% CI: 3.1 to 4.6 vs. 3.4% 95% CI: 2.5 to 4.5). Similarly, there was no difference in pooled 30-day stroke post TAVR between the CoreValve and Edwards Valve in multicenter (2.4% 95% CI: 1.9 to 3.2 vs. 3.0% 95% CI: 2.4 to 3.7) and single-center studies (3.8% 95% CI: 2.8 to 4.9 vs. 3.2% 95% CI: 2.4 to 4.3). There was a decline in stroke risk with experience and technological advancement. There was no difference in the outcome of 30-day stroke between TAVR and surgical aortic valve replacement. Conclusions Our findings suggest that the risk of 30-day stroke after TAVR is similar between the approaches and valve types. There has been a decline in stroke risk after TAVR with improvements in valve technology, patient selection, and operator experience.
Transcatheter aortic valve replacement (TAVR) is a transformative technology that has changed the management of patients with severe, symptomatic aortic stenosis. The use of TAVR in intermediate- to ...high-risk patients has been validated in several rigorously performed, randomized clinical trials. Recent studies using newer generation devices have demonstrated the noninferiority of TAVR as compared with surgical aortic valve replacement in low-risk patients, supporting the increased utilization and expansion of TAVR. The use of TAVR in low-risk patients has important implications and requires a multifaceted approach that includes a highly functional multidisciplinary heart team for careful patient selection; a need to understand and help mitigate certain key complications, such as stroke, paravalvular regurgitation, and conduction disturbances; careful data collection for continual outcome assessment and improvement; and the necessary expertize and procedural volume to maintain excellent outcomes and ensure optimal clinical care pathways.
The coronavirus pandemic has spread globally and resulted in the registered deaths of over 5.5 million people, with nearly 380 million infected, straining health systems focused on transmission ...suppression and supportive care because specific treatment options are limited. COVID-19 is a microvascular disease with dominant respiratory representation, but a significant number of patients experience multisystem or extrarespiratory organ involvement. Although severe acute respiratory syndrome coronavirus-2 has some degree of a direct cytopathic effect on cardiomyocytes, the oxidative burst on a microvascular level seems to be the key for both short- and long-term adverse health effects. Targeted diagnostics and treatment without substantial delay may reduce the amplified immune response; otherwise, considerable tissue damage may occur with unfavourable consequences, including acute and chronic cardiac syndromes. This paper reviews the pathomechanisms relevant to the short- and long-term cardiac effects of COVID-19. Data were identified by searching the PubMed database and reviewing references from relevant articles published in English; abstracts and meeting reports were excluded.
Abstract Background Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a ...lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab. Methods All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab. Results After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trend < 0.001). Similarly, the percentage of cases with an aggregate on-time start increased from 41.7% in 2009 to 62.8% in 2012 (p-trend < 0.001). In addition, the percentage of manual sheath-pulls performed in the Cath Lab decreased from 60.7% in 2009 to 22.7% in 2012 (p-trend < 0.001). Conclusions The current longitudinal study illustrates the impact of successful implementation of a well-known process improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab.
Transcatheter aortic valve replacement (TAVR) is a rapidly evolving technology that has been accepted as a treatment option in patients with severe aortic stenosis who are not suitable for or are at ...high risk for conventional surgery. Randomized trials have shown that TAVR decreases mortality and improves quality of life in patients who are not suitable for conventional surgery and that TAVR is not inferior to standard surgery in operable but high- risk patients. However, TAVR has several important limitations, the most prominent of which is residual paravalvular aortic regurgitation (PAR). The purpose of this review is to present the mechanism, incidence, assessment, and treatment of PAR after TAVR.
The study undertook a systematic review to establish and compare the risk of stroke between the 2 widely used approaches (transfemoral TF vs. transapical TA) and valve designs (CoreValve, Medtronic, ...Minneapolis, Minnesota vs. Edwards Valve, Edwards Lifesciences, Irvine, California) for transcatheter aortic valve replacement (TAVR).
There has been a rapid adoption and expansion in the use of TAVR. The technique is however far from perfect and requires further refinement to alleviate safety concerns that include stroke.
All studies reporting on the risk of stroke after TAVR were identified using an electronic search and pooled using established meta-analytical guidelines.
25 multicenter registries and 33 single-center studies were included in the analysis. There was no difference in pooled 30-day stroke post-TAVR between the TF and TA approach in multicenter (2.8% 95% confidence interval (CI): 2.4 to 3.4 vs. 2.8% 95% CI: 2.0 to 3.9) and single-center studies (3.8% 95% CI: 3.1 to 4.6 vs. 3.4% 95% CI: 2.5 to 4.5). Similarly, there was no difference in pooled 30-day stroke post TAVR between the CoreValve and Edwards Valve in multicenter (2.4% 95% CI: 1.9 to 3.2 vs. 3.0% 95% CI: 2.4 to 3.7) and single-center studies (3.8% 95% CI: 2.8 to 4.9 vs. 3.2% 95% CI: 2.4 to 4.3). There was a decline in stroke risk with experience and technological advancement. There was no difference in the outcome of 30-day stroke between TAVR and surgical aortic valve replacement.
Our findings suggest that the risk of 30-day stroke after TAVR is similar between the approaches and valve types. There has been a decline in stroke risk after TAVR with improvements in valve technology, patient selection, and operator experience.
Polyvascular disease (PolyVD) is the presence of atherosclerosis in multiple vascular territories and is associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCE). ...Our study aims to draw attention to the prevalence and outcomes of PolyVD in patients presenting with acute coronary syndrome (ACS) in the Gulf region. Highlighting the disease burden of PolyVD in our population will lead to more vigilant surveillance, better clinical outcomes, and improved quality of life. Data from 685 adults who presented with ACS from January 2015 to June 2020 was reviewed retrospectively. We evaluated lower extremity artery disease (LEAD) and cerebrovascular disease (CVD) using ABI and carotid duplex. Thirty-five percent (n = 238) of patients had PolyVD. 70% patients with LEAD and 65% patients with CVD were asymptomatic. PolyVD was associated with an increased likelihood (aOR,1.69 1.02-2.81; P = 0.03) of MACCE at 1-year. Since the progression of atherosclerosis is an insidious process, most patients remain asymptomatic before presenting with fatal vascular events.
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