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Archive for the ‘Atherogenic Processes & Pathology’ Category


The Promise of Low-Dose Aspirin on Longevity in the Geriatric Population: No Effect on Outcomes in the US and Australia

Reporter: Aviva Lev-Ari, PhD, RN

 

Daily Low-Dose Aspirin Found to Have No Effect on Healthy Life Span in Older People?

According to 3 articles published online The New England Journal of Medicine (16 September 2018), daily low-dose aspirin was found to have no effect on healthy life span in older people. This large NIH-funded study examined outcomes in United States and Australia

Results showed that in a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events,

Aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability).

Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health.

ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a physical disability and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.

In the total study population, treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin,

  • 90.3% remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5% of those taking a placebo.
  • Rates of physical disability were similar, and rates of dementia were almost identical in both groups. However,
  • the group taking aspirin had an increased risk of death compared to the placebo group: 5.9% of participants taking aspirin and 5.2% taking placebo died during the study.

This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance. The authors also analyzed the ASPREE results to determine whether cardiovascular events took place. They found that

  • the rates for major cardiovascular events — including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke — were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.

Significant bleeding — a known risk of regular aspirin use — was also measured. The authors noted that

  • aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding — hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization — occurred in 361 people (3.8%) on aspirin and in 265 (2.7%) taking the placebo.
  • As would be expected in an older adult population, cancer was a common cause of death, and 50% of the people who died in the trial had some type of cancer.
  • Heart disease and stroke accounted for 19% of the deaths and major bleeding for 5%.

The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants. As these efforts continue, the authors emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin’s effects in people younger than age 65. Also, since only 11% of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE’s findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.

SOURCE

From: OnTarget <ontarget@targethealth.com>

Date: September 23, 2018 at 10:47:06 PM EDT

To: avivalev-ari@alum.berkeley.edu

Subject: OnTarget Newsletter

 

Other 121 articles on ASPIRIN were published in this Open Access Online Scientific Journal, including the following:

https://pharmaceuticalintelligence.com/?s=Aspirin

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Aortic Stenosis (AS): Managed Surgically by Transcatheter Aortic Valve Replacement (TAVR) – Search Results for “TAVR” on NIH.GOV website, Top 16 pages

Reporter: Aviva Lev-Ari, PhD, RN

 

UPDATED on 9/24/2018

Sapien 3, CoreValve Evolut R on Par for Aortic Stenosis

Head-to-head trial also shows local, general anesthesia outcomes similar

by Ashley Lyles, Staff Writer, MedPage Today

  • This article is a collaboration between MedPage Today® and:

    Medpage Today

SAN DIEGO — Transfemoral transcatheter aortic valve replacement (TAVR) with the balloon-expandable Edwards Sapien 3 valve yields the same early outcomes as the self-expanding CoreValve Evolut R, regardless of anesthesia strategy, a two-by-two randomized trial showed.

In the valve comparison, the primary endpoint of all-cause mortality, stroke, moderate or severe prosthetic valve regurgitation, and permanent pacemaker implantation at 30 days met criteria for equivalence, with a composite rate of 27.2% with Evolut R and 26.1% with Sapien 3, Holger Thiele, MD, of University Hospital in Leipzig, Germany, reported here at the Transcatheter Cardiovascular Therapeutics meeting.

The researchers also evaluated the effects of anesthesia used during these procedures and found no significant difference. The composite endpoint at 30 days came out 27.0% for local anesthesia and 25.5% for general anesthesia.

“The SOLVE-TAVI trial is the first adequately powered randomized trial comparing local versus general anesthesia in patients with symptomatic aortic valve stenosis undergoing TAVR,” said Thiele in a press release. “Results indicate that local anesthesia is both safe and effective and may be a good option for those patients undergoing TAVR with an intermediate or high surgical risk.”

In the majority of aortic stenosis cases, it doesn’t matter which valve you choose, although there are still some cases, like heavy calcification, when it may be better to choose one valve over the other, noted panel discussant Molly Szerlip, MD, of Baylor Scott & White The Heart Group in McKinney, Texas.

The researchers evaluated 447 patients who were receiving care at German medical centers for severe symptomatic aortic stenosis and were at an intermediate- to high-surgical risk. The patients were randomized to have the Sapien 3 valve or CoreValve Evolut R and to either receive general or local anesthesia with conscious sedation.

The individual valve strategy findings again showed equivalence without superiority between Evolut R and Sapien 3 for mortality (2.8% vs 2.3%) and moderate or severe valve regurgitation (1.9% vs 1.4%). But for stroke Evolut R came out superior (0.5% vs 4.7%), and the two didn’t meet criteria for equivalence on pacemaker implantation (22.9% vs 19.0%, P=0.06 for equivalence).

“The rate of relevant valve regurgitation was low whereas permanent pacemaker rates are still relatively high,” the researchers wrote.

The anesthesia comparison endpoints all met the criteria for equivalence without superiority of general anesthesia over local anesthesia:

  • Morality (2.3% vs 2.8%)
  • Stroke (2.8% vs 2.4%)
  • Myocardial infarction (both 0.5%)
  • Infection requiring antibiotics (both 21.0%)
  • Acute kidney injury (9.2% vs 8.9%)

SOURCE

https://www.medpagetoday.com/meetingcoverage/tct/75262?xid=nl_mpt_ACC_Reporter_2018-09-23&eun=g5099207d2r

 

The concept of transcatheter balloon expandable valves was first introduced in the 1980s by a Danish researcher by the name of H. R. Anderson who began testing this idea on pigs. In 2002, Dr. Alain Cribier performed the first successful percutaneous aortic valve replacement on an inoperable patient. The first approval of TAVR for the indication of severe AS in prohibitive risk patients came in 2011. In 2012, the FDA approved TAVR in patients at high surgical risk. In 2015 the indication was expanded to include “valve-in-valve” procedure for failed surgical bioprosthetic valves. Most recently, in 2016 the FDA approved the SAPIEN valve for use in patients with severe AS at intermediate risk.

SOURCE

https://www.ncbi.nlm.nih.gov/pubmed/28613729

 

Critical care management of patients following …

Transcatheter aortic valve replacement (TAVR) is rapidly gaining popularity as a technique to surgically manage aortic stenosis (AS) in high risk …

Imaging in Transcatheter Aortic Valve Replacement (TAVR …

Transcatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are …

TAVR and SAVR: Current Treatment of Aortic Stenosis

Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011, providing a critically needed alternative therapy for …

Transcatheter Aortic Valve Replacement: Design, Clinical …

Transcatheter aortic valve replacement (TAVR) is a new technology that recently has been shown to improve survival and quality of life in patients …

Cost-Effectiveness Analysis of TAVR

Transcather aortic valve replacement (TAVR) has rapidly gained worldwide acceptance for treating very high-risk patients with symptomatic severe …

Clinical Studies Assessing Transcatheter Aortic Valve …

Extreme-Risk or Inoperable Patients for sAVR. Early clinical evaluation of TAVR included patients deemed unsuitable for sAVR. The logistic Euroscore …

Mitral Valve Surgery: Current Minimally Invasive and …

Minimally Invasive Mitral Valve Repair or Replacement. Most MV pathology can be treated with minimally invasive, … As we learned from the TAVR …

Transcatheter (TAVR) versus surgical (AVR) aortic valve …

The risk in the early phase was higher after TAVR than AVR, and in the TAVR arm in patients with a smaller aortic valve area index. In the late risk …

Procedure makes heart valve replacement safer for high-risk patients

4 months ago – Scientists developed a novel technique that prevents a rare but often fatal complication that can arise during a heart valve procedure called …

Sedation or general anesthesia for transcatheter aortic …

Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and …

Transcatheter aortic valve replacement: outcomes of …

Transcatheter aortic valve replacement: outcomes of patients with moderate or severe mitral regurgitation. Toggweiler S(1), … One year after TAVR …

Outcomes in Transcatheter Aortic Valve Replacement for …

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).

New method for performing aortic valve replacement proves …

Researchers at the National Institutes of Health have developed a new, less invasive way to perform transcatheter aortic valve replacement (TAVR), a …

Acquired Aorto-Right Ventricular Fistula following …

Transcatheter aortic valve replacement (TAVR) techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the …

Post Transapical Aortic Valve Replacement (TAVR …

A 63-year-old female presented to the emergency department with complaints of her “heart beating out of my chest,” palpitations, and shortness of …

Surgical or Transcatheter Aortic-Valve Replacement in …

Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. … Although transcatheter aortic-valve replacement (TAVR) …

Transcatheter aortic valve replacement versus surgical …

Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Thourani VH(1) …

Transcatheter aortic valve replacement (TAVR): access …

Ramlawi B(1), Anaya-Ayala JE, Reardon MJ. Author information: (1)Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas …

Simulation of Transcatheter Aortic Valve Replacement in …

Simulation of Transcatheter Aortic Valve Replacement in patient-specific aortic roots: … Transcatheter aortic valve replacement (TAVR), …

Simulation of Transcatheter Aortic Valve Replacement in …

Simulation of Transcatheter Aortic Valve Replacement in patient-specific aortic roots: … Transcatheter aortic valve replacement (TAVR), …

Transcatheter Aortic Valve Replacement Versus Surgery in …

The objective of this study was to compare outcomes in women after surgical aortic valve replacement … transcatheter aortic valve replacement (TAVR) …

Lederman Lab – NHLBI Cardiovascular Intervention Program

ledermanlab.nhlbi.nih.gov/

Transcaval TAVR was developed at the NHLBI Cardiovascular Intervention Program and applied to patient care in collaboration with Dr. Adam Greenbaum at …

Functional status and quality of life after transcatheter …

Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. BACKGROUND: The functional and quality-of-life benefits of transcatheter aortic valve …

One-Year Outcomes of Transcatheter Aortic Valve …

1. Ann Thorac Surg. 2017 May;103(5):1392-1398. doi: 10.1016/j.athoracsur.2016.11.061. Epub 2017 Feb 24. One-Year Outcomes of Transcatheter Aortic …

Local versus general anesthesia for transcatheter aortic …

Now randomized trials are needed for further evaluation of MAC in the setting of TAVR. PMCID: PMC4022332 PMID: 24612945 [PubMed – indexed for MEDLINE]

Predictors and clinical outcomes of permanent pacemaker …

CONCLUSIONS: PPM was required in 8.8% of patients without prior PPM who underwent TAVR with a balloon-expandable valve in the PARTNER trial and …

Transcatheter aortic valve replacement program development …

TAVR programs require data management strategies to facilitate and monitor program growth, support program evaluation, and meet the requirements for …

New technique makes heart valve replacement safer for some …

Lederman explained that during TAVR, the surgeon places a catheter inside the heart and uses a balloon to open a new valve inside the aortic valve.

Minimally invasive aortic valve replacement using the …

The term “sutureless aortic valve” (su-AV) describes a type of valve which facilitates anchoring of bioprostheses in the aortic position without use …

Use of extracorporeal membrane oxygenation in complicated …

1. Gen Thorac Cardiovasc Surg. 2017 Feb 24. doi: 10.1007/s11748-017-0757-1. [Epub ahead of print] Use of extracorporeal membrane oxygenation in …

Reoperative aortic valve replacement through upper …

Reoperative aortic valve replacement (AVR) has become increasingly common . … but who may not be considered eligible for TAVR procedure.

MRI evaluation prior to Transcatheter Aortic Valve …

MRI evaluation prior to Transcatheter Aortic Valve Implantation … Transcatheter Aortic Valve Implantation (TAVI) … imaging for TAVR assessment in …

Impact of New-Onset Left Bundle Branch Block and …

New-onset LBBB post-TAVR was associated with a higher risk of PPI (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.28-3.70) and cardiac death …

Migration of the transcatheter valve into the left ventricle

Transcatheter valves can embolize into the aorta if the valve is malpositioned too high or, less commonly, migrate into the left ventricle when the …

Transcarotid Transcatheter Aortic Valve Replacement …

All patients were unsuitable for transfemoral TAVR due to severe peripheral vascular disease. An MIS was undertaken in 29.8% (n = 52) …

The transaortic approach for transcatheter aortic valve …

The transaortic approach for transcatheter aortic valve replacement: initial clinical experience in the United States. Lardizabal JA(1), O’Neill BP …

Transcatheter Aortic Valve Replacement: The New Standard …

Transcatheter Aortic Valve Replacement: The … The aim of this study was to assess how the introduction of transcatheter aortic valve replacement (TA …

Minimally invasive aortic valve surgery: state of the art …

Minimally invasive aortic valve replacement (MIAVR) is defined as an aortic valve replacement (AVR) procedure that involves a small chest wall …

Prognostic impact of pulmonary artery systolic pressure in …

Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve … TAVR was associated with a decrease in …

Transcatheter Aortic Valve Replacement is Associated with …

This meta-analysis aims to assess the differential outcomes of TAVR and SAVR in patients enrolled in published randomised controlled trials (RCTs).

Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic …

There were no differences between groups in valve hemodynamic status post-TAVR. CONCLUSIONS: This small trial showed that SAPT (vs. DAPT) …

Upper gastrointestinal bleeding following transcatheter …

Upper gastrointestinal bleeding following transcatheter aortic valve replacement: A retrospective analysis. Stanger DE(1), … (TAVR). BACKGROUND: …

Computed tomography-based sizing recommendations for …

Consecutive patients (n = 120) underwent CT before TAVR with balloon-expandable valves sized by transesophageal echocardiography (TEE) …

European experience and perspectives on transcatheter …

European experience and perspectives on transcatheter aortic valve replacement. Davies WR(1), Thomas MR(2).

[PDF] Mandatory Reporting of Clinical Trial Identifier Numbers …

accrualnet.cancer.gov/sites/accrualnet.cancer.gov/files/Mandatory%20Reporting%20of%20Clinical%20Trial%20Identifier%20FAQs.pdf

Mandatory Reporting of Clinical Trial Identifier Numbers on Claims . Q: Do organizations bill Medicare for all services related to the clinical trial …

Transcatheter Aortic Valve Replacement: Imaging Techniques …

Transcatheter Aortic Valve Replacement: Imaging Techniques for Aortic Root Sizing. Wichmann JL(1), Varga-Szemes A, Suranyi P, Bayer RR 2nd, Litwin SE …

Transcatheter Aortic Valve Thrombosis: Incidence …

METHODS: Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, …

Sutureless aortic valve replacement – PubMed Central (PMC)

Given its recent developments, the majority of evidence regarding sutureless aortic valve replacement (SU-AVR) is limited to observational studies …

Comparison of balloon-expandable vs self-expandable valves …

Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valvereplacement: … (TAVR) is an effective …

Geometric changes in ventriculoaortic complex after …

Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association … The post-TAVR AoA area/pre-TAVR AoA …

Acute and 30-Day Outcomes in Women After TAVR: Results …

Randomized assessment of TAVR versus surgical aortic valve replacement in intermediate risk women is warranted to determine the optimal strategy.

Should We Perform Carotid Doppler Screening Before …

Should We Perform Carotid Doppler Screening Before Surgical or Transcatheter Aortic Valve Replacement? … (TAVR) between January 2007 and August …

Transcatheter Versus Surgical Aortic Valve Replacement in …

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis.

Risk stratification and clinical pathways to optimize …

Risk stratification and clinical pathways to optimize length of stay after … We evaluated standardized TAVRoutcomes and length of stay according to …

Use of imaging for procedural guidance during …

1. Curr Opin Cardiol. 2013 Sep;28(5):512-7. doi: 10.1097/HCO.0b013e3283632b5e. Use of imaging for procedural guidance during transcatheter aortic …

Serial Changes in Cognitive Function Following …

Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement. Auffret V(1), Campelo-Parada F(1), Regueiro A(1), …

Acute kidney injury after transcatheter aortic valve …

Acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis. Thongprayoon C(1), Cheungpasitporn W, Srivali …

Aortic valve replacement – PubMed Health

Transcatheter aortic valve replacement (TAVR), sometimes called transcatheter aortic valve implantation (TAVI), was developed as an alternative for …

Costs of periprocedural complications in patients treated …

Costs of periprocedural complications in patients treated with transcatheter aortic valve replacement: … Renal failure and the need for repeat TAVR …

Trial design: Rivaroxaban for the prevention of major …

The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO …

Expandable sheath for transfemoral transcatheter aortic …

Expandable sheath for transfemoral transcatheter aortic valve replacement: procedural outcomes and complications. Borz B(1), Durand E, Tron C, …

Direct Aortic Access Transcatheter Aortic Valve …

Direct Aortic Access Transcatheter Aortic Valve Replacement: Three-Dimensional Computed Tomography Planning and Real … was selected for DA-TAVR …

The impact of frailty on outcomes after cardiac surgery: a …

1. J Thorac Cardiovasc Surg. 2014 Dec;148(6):3110-7. doi: 10.1016/j.jtcvs.2014.07.087. Epub 2014 Aug 7. The impact of frailty on outcomes after …

Establishment of a transcatheter aortic valve program and …

Establishment of a transcatheter aortic valve program and heart valve team at a Veterans Affairs facility. … (TAVR) program.

Echocardiographic determinants of LV functional …

Echocardiographic determinants of LV functional improvement after transcatheter aortic valve replacement. … Transcatheter aortic valve replacement ( …

CT in transcatheter aortic valve replacement.

CT in transcatheter aortic valve replacement. … the rapidly emerging role of CT in the context of transcatheter aortic valve replacement will be …

Transcatheter Aortic Valve Replacement for the Treatment …

Transcatheter Aortic Valve Replacement for the … This study sought to summarize available evidence on transcatheter aortic valve replacement (TAVR) …

Valvular performance and aortic regurgitation following …

End points were post-TAVR moderate to severe AR and paravalvular AR, effective orifice area (EOA), mean trans-aortic pressure gradient (MPG), …

Annual Outcomes With Transcatheter Valve Therapy: From the …

Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry. Holmes DR Jr, Nishimura RA, Grover FL, Brindis RG, Carroll JD …

The impact of live case transmission on patient outcomes …

The impact of live case transmission on patient outcomes during transcatheter aortic valve replacement: … Data support the notion that live …

Review of Major Registries and Clinical Trials of Late …

Review of Major Registries and Clinical Trials of Late Outcomes After Transcatheter … Final studies were selected irrespective of the type of TAVR …

Trans-subclavian aortic valve replacement with various …

Trans-subclavian aortic valve replacement with various bioprosthetic valves: Single-center experience. Kasapkara HA(1), Aslan AN(2), Ayhan H(1), …

Vascular complications post-transcatheter aortic valve …

Vascular complications post-transcatheter aortic valve procedures. Mangla A(1), Gupta S(2). Author information: (1)Division of Cardiology, Department …

[Monitoring of haemodynamics and function of the aortic …

[Monitoring of haemodynamics and function of the aortic prosthesis during transcatheter aortic valve replacement]. [Article in Russian]

Midregional Proadrenomedullin Improves Risk Stratification …

Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve … (TAVR …

Midregional Proadrenomedullin Improves Risk Stratification …

Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve … (TAVR …

Dual Versus Single Antiplatelet Regimen With or Without …

Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in Transcatheter Aortic Valve … (TAVR), with dual antiplatelet therapy …

Impact of baseline mitral regurgitation on short- and long …

Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic … before the index TAVR procedure was …

TAVRassociated prosthetic valve infective endocarditis …

TAVRassociated prosthetic valve infective endocarditis: results of a large, multicenter registry. Latib A, Naim C, De Bonis M, Sinning JM, …

Mechanisms of Heart Block after Transcatheter Aortic Valve …

Consequently, patients undergoing TAVR are prone to peri-procedural complications including cardiac conduction disturbances, which is the focus of …

JACC. Cardiovascular Imaging – Journals – NCBI

JACC. Cardiovascular Imaging journal page at PubMed Journals. Published by Elsevier

Short-Term Outcomes with Direct Aortic Access for …

Short-Term Outcomes with Direct Aortic Access for Transcatheter Aortic Valve Replacement. Ramlawi B, Abu Saleh WK, Jabbari OA, Barker C, Lin C, … (T …

Impact of patient-prosthesis mismatch after transcatheter …

Impact of patient-prosthesis mismatch after transcatheter aortic valve-in-valve implantation in degenerated bioprostheses. Seiffert M(1), Conradi L …

Extent and distribution of calcification of both the …

AR grade 2 to 4 assessed by the method of Sellers immediately after TAVR device implantation was observed in 55 patients (31%). Multivariate …

Safety, Feasibility, and Hemodynamic Effects of Mild …

Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in Transcatheter Aortic Valve Replacement: The TAVR … feasibility, and hemodynamic …

Transcatheter aortic valve implantation: anesthetic …

Transcatheter aortic valve implantation: anesthetic considerations. Billings FT 4th(1), Kodali SK, Shanewise JS. Author information: (1)Departments of …

RFA-HL-19-009: Cardiothoracic Surgical Trials Network …

grants.nih.gov/grants/guide/rfa-files/RFA-HL-19-009.html

Bicuspid aortic valve disease has been excluded from TAVR pivotal trials, but TAVR is increasingly used in this population, despite …

www.ncbi.nlm.nih.gov

Moved Permanently. The document has moved here.

Outcome comparison of African-American and Caucasian …

METHODS: Consecutive patients who underwent TAVR were included in this analysis. Patients’ baseline characteristics, procedural data, …

Incidence and predictors of permanent pacemaker …

Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve.

Effect of Hospital Volume on Outcomes of Transcatheter …

Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation. Badheka AO(1), Patel NJ(2), Panaich SS(3), Patel SV(4), …

Aortic valve sizer for TAVR | NIH 3D Print Exchange

3dprint.nih.gov/discover/3dpx-007958

This sizer is designed to simulate the insertion of heart valve prosthetics into 3d printed patient phantoms. It is loosely based on the size …

Health Topics | National Heart, Lung, and Blood Institute …

Materials for patients and health professionals on health topics related to overweight and obesity, heart, lung, blood, and sleep disorders.

DailyMed – ASPIRIN 81MG ADULT LOW DOSE- aspirin tablet …

dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14d010fb-c4a1-4c3d-942f-58719727bfc0

ASPIRIN 81MG ADULT LOW DOSE- aspirin tablet, delayed release . To receive this label RSS feed. Copy the URL below and paste it into your RSS Reader …

Incidence and predictors of permanent pacemaker …

Incidence and predictors of permanent pacemaker implantation following treatment with the repositionable Lotus™ transcatheter aortic valve.

Aortic valve sizer for TAVR | NIH 3D Print Exchange

3dprint.nih.gov/discover/3dpx-007958

This sizer is designed to simulate the insertion of heart valve prosthetics into 3d printed patient phantoms. It is loosely based on the size …

Transcatheter Aortic Valve Replacement in Severe Aortic …

1. Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis: A Review of Comparative Durability and Clinical Effectiveness Beyond 12 Months …

Sigmoid Septum and Balloon-Expandable Transcatheter Aortic …

de Biasi AR, Worku B, Skubas NJ, Salemi A. Transcatheter aortic valve replacement (TAVR) continues to garner considerable attention, especially as the …

Intra- and Inter-Observer Reproducibility of Transcatheter …

Intra- and Inter-Observer Reproducibility of Transcatheter Aortic Valve Replacement Planning Measurements by Multidetector … of the pre-TAVR …

www.ncbi.nlm.nih.gov

Moved Permanently. The document has moved here.

Transthoracic Echocardiography to Assess Aortic …

Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVRA Comparison with Periprocedural Transesophageal Echocardiography.

Procedural Experience for Transcatheter Aortic Valve …

Procedural Experience for Transcatheter Aortic Valve Replacement and Relation to Outcomes: The STS/ACC TVT Registry. Carroll JD(1), Vemulapalli S(2) …

A comprehensive review of the PARTNER trial.

Svensson LG(1), Tuzcu M, Kapadia S, Blackstone EH, Roselli EE, Gillinov AM, Sabik JF 3rd, Lytle BW. Author information: (1)Department of Thoracic and …

TCT-697 Comparison of Outcomes of Transcatheter Aortic …

TCT-697 Comparison of Outcomes of Transcatheter Aortic Valve Replacement plus Percutaneous Coronary Intervention versus Transcatheter Aortic Valve …

Combined rotational atherectomy and aortic balloon …

Combined rotational atherectomy and aortic balloon valvuloplasty as a bridge to transcatheter aortic valve replacement. Ali O(1), Marmagkiolis K(2) …

Updated standardized endpoint definitions for …

1. Eur J Cardiothorac Surg. 2012 Nov;42(5):S45-60. doi: 10.1093/ejcts/ezs533. Epub 2012 Oct 1. Updated standardized endpoint definitions for …

Clinical outcomes after transcatheter aortic valve …

CONCLUSIONS: VARC definitions have already been used by the TAVR clinical research community, establishing a new standard for reporting clinical …

2012 ACCF/AATS/SCAI/STS expert consensus document on …

2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. Holmes DR Jr, Mack MJ, Kaul S, Agnihotri A, Alexander KP …

Combined rotational atherectomy and aortic balloon …

Combined rotational atherectomy and aortic balloon valvuloplasty as a bridge to transcatheter aortic valve replacement. Ali O(1), Marmagkiolis K(2) …

Clinical outcomes after transcatheter aortic valve …

CONCLUSIONS: VARC definitions have already been used by the TAVR clinical research community, establishing a new standard for reporting clinical …

TAVR MVR – PubMed Result – ncbi.nlm.nih.gov

1: Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, Brindis RG, Shahian DM, Ruiz CE, Jacobs JP, Hanzel G, Bavaria JE, Tuzcu EM …

Aortic valve calcium scoring is a predictor of …

Aortic valve calcium scoring is a predictor of paravalvular aortic regurgitation after transcatheter aortic valve implantation

Transcatheter Aortic Valve-in-Valve Replacement Instead of …

Díez JG, Schechter M, Dougherty KG, Preventza O, Coselli JS. Transcatheter aortic valve replacement (TAVR) is a well-established method for replacing …

Coronary Calcium Scan | National Heart, Lung, and Blood …

Buildup of calcium, or calcifications, are a sign of atherosclerosis, coronary heart disease, or coronary microvascular disease. A coronary calcium …

An update on transcatheter aortic valve replacement.

An update on transcatheter aortic valve replacement. … Before the development of transcatheter aortic valve replacement (TAVR … and noninferiority …

The Iowa Model of Evidence-Based Practice to Promote …

The Iowa Model of Evidence-Based Practice to Promote Quality Care: an illustrated example in oncology nursing. Brown CG(1). Author information: …

Two-Year Outcomes in Patients With Severe Aortic Valve …

There was no difference in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%, respectively; P=0.54) or cardiovascular mortality …

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PubMed comprises more than 28 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include …

Integrated 3D Echo-X-Ray navigation to predict optimal …

Integrated 3D Echo-X-Ray navigation to predict optimal angiographic deployment projections for TAVR. Kim MS, Bracken J, Nijhof N, Salcedo EE, Quaife …

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Cardiac rehabilitation after transcatheter aortic valve implantation compared to patients after valve replacement. Tarro Genta F(1), Tidu M, Bouslenko …

TAVR | NIH 3D Print Exchange

3dprint.nih.gov/discover/tavr

TAVR. Discover > TAVR. 3DPX-007958 Aortic valve sizer for TAVR ahmedhosny. TAVR, aortic valve, sapienXT, heart valve, sizer, Prosthetic. Discover 3D …

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Imaging Pandora’s Box: incidental findings in elderly …

Imaging Pandora’s Box: incidental findings in elderly patients evaluated for transcatheter aortic valve replacement. Orme NM(1), Wright TC(2), Harmon …

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TCT-753 Fascia Iliaca Compartment Block (FICB) and None to Light Sedation as an Alternative Minimalist Approach to Sedation for Patients Undergoing …

Stents | National Heart, Lung, and Blood Institute (NHLBI)

For the Coronary Arteries. Doctors may use stents to treat coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque …

TAVR | NIH 3D Print Exchange

3dprint.nih.gov/discover/tavr

TAVR. Discover > TAVR. 3DPX-007958 Aortic valve sizer for TAVR ahmedhosny. TAVR, aortic valve, sapienXT, heart valve, sizer, Prosthetic. Discover 3D …

Imaging Pandora’s Box: incidental findings in elderly …

Imaging Pandora’s Box: incidental findings in elderly patients evaluated for transcatheter aortic valve replacement. Orme NM(1), Wright TC(2), Harmon …

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[PDF] Transmural” catheter interventions for congenital and …

demystifyingmedicine.od.nih.gov/dm16/m03d22/DM-LedermanRJ.pdf

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Stroke and thromboembolic events after transfemoral aortic valve replacement (TAVR) continue to be a problem. The aim of our study was to compare …

Discover 3D Models | NIH 3D Print Exchange

3dprint.nih.gov/discover?terms=&field_model_category_tag_tid%5B0%5D=93&field_model_license_nid=All&sort_by=created&sort_order=DESC&items_per_page=24&page=2

Discover 3D Models . Back To Top. Search . Enter terms, … 3DPX-007958 Aortic valve sizer for TAVR. ahmedhosny. 3DPX-007884 Fly Pad. Joyner Cruz …

Beyond PARTNER: appraising the evolving trends and …

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Beyond PARTNER: appraising the evolving trends and …

Beyond PARTNER: appraising the evolving trends and outcomes in transcatheter aortic valve replacement. … TAVR may become an alternative to surgical …

Echocardiographic imaging of procedural complications …

Echocardiographic imaging of procedural complications during self-expandable transcatheter aortic valve replacement. Hahn RT(1), Gillam LD(2), Little …

Digest – The NIH Record – November 18, 2016

nihrecord.nih.gov/newsletters/2016/11_18_2016/digest.htm

For about 85 percent of patients with this condition, doctors typically perform TAVR through the femoral artery in the leg. But for the other 15 …

Electrocardiographic changes and clinical outcomes after …

Gutiérrez M(1), Rodés-Cabau J, Bagur R, Doyle D, DeLarochellière R, Bergeron S, Lemieux J, Villeneuve J, Côté M, Bertrand OF, Poirier P, Clavel MA …

Coronary Artery Bypass Grafting | National Heart, Lung …

Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Surgeons use CABG to treat people who have severe …

Heart Surgery | National Heart, Lung, and Blood Institute …

Heart surgery is done to correct problems with the heart. Many heart surgeries are done each year in the United States for various heart problems. The …

Aspirin-clopidogrel no better than aspirin alone for …

NIH study also shows that overall stroke risk is down from 10 years ago. Aspirin combined with the antiplatelet drug clopidogrel is no better than asp …

Heart Valve Disease | National Heart, Lung, and Blood …

Heart valve disease occurs if one or more of your heart valves don’t work well. The heart has four valves: the tricuspid, … (TAVR). For this …

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Echo Doppler Estimation of Pulmonary Capillary Wedge …

Echo Doppler Estimation of Pulmonary Capillary Wedge Pressure in Patients with … (TAVR) has become a … Noninvasive quantification of pulmonary …

Aspirin-clopidogrel no better than aspirin alone for …

NIH study also shows that overall stroke risk is down from 10 years ago. Aspirin combined with the antiplatelet drug clopidogrel is no better than asp …

Could late enhancement and need for permanent pacemaker …

Could late enhancement and need for permanent pacemaker implantation in patients undergoing TAVR be explained by undiagnosed transthyretin cardiac …

Diabetes mellitus is associated with increased acute …

However, there are conflicting data on the impact of DM on outcomes of transcatheter aortic valve replacement (TAVR). HYPOTHESIS: …

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Cardiac catheterization (KATH-eh-ter-ih-ZA-shun) is a medical procedure used to diagnose and treat some heart conditions. A long, thin, flexible tube …

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consensus.nih.gov/1984/1984FrozenPlasma045html.htm

Fresh Frozen Plasma: Indications and Risks. National Institutes of Health Consensus Development Conference Statement September 24-26, 1984

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Successful repair of aortic annulus rupture during transcatheter aortic valve replacement using extracorporeal membrane oxygenation support. Negi …

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Fluoroscopy-guided aortic root imaging for TAVR: “follow …

Fluoroscopy-guided aortic root imaging for TAVR: “follow the right cusp” rule. Kasel AM, Cassese S, Leber AW, von Scheidt W, Kastrati A.

Reply: Aortic Stiffness: Complex Evaluation But Major …

Reply: Aortic Stiffness: Complex Evaluation But Major Prognostic Significance Before TAVR. Yotti R, Bermejo J, Gutiérrez-Ibañes E, …

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ventricular assist device (VAD) is a mechanical pump that supports heart function and blood flow in people who have weakened hearts.

Severe Symptomatic Aortic Stenosis in Older Adults …

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Aortic Stiffness: Complex Evaluation But Major Prognostic Significance Before TAVR. Harbaoui B, Courand PY, Girerd N, Lantelme P.

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MeSH (Medical Subject Headings) is the NLM controlled vocabulary thesaurus used for indexing articles for PubMed.

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TCT-712 “Cusp Overlap” View Facilitates Accurate Fluoro-Guided Implantation of Self-Expanding Valve in TAVR. Zaid S, Raza A, Michev I, Ahmad H, Kaple …

Incidence and risk factors of hemolysis after …

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Insurance Coverage and Clinical Trials – National Cancer …

Insurance Coverage and Clinical Trials. Federal law requires most health insurance plans to cover routine patient care costs in clinical … National …

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openi.nlm.nih.gov/detailedresult.php?img=PMC3431975_cmc-6-2012-125f4&req=4

PARTNER trial data showing superior outcomes from TAVI vs. standard therapy for death at 1 and 2 years for: (A) death from any cause, and (B) death …

Transthoracic echocardiography guidance for TAVR under …

Transthoracic echocardiography guidance for TAVR under monitored anesthesia care. Sengupta PP, Wiley BM, Basnet S, Rajamanickman A, Kovacic JC …

Incidence and risk factors of hemolysis after …

1. Am J Cardiol. 2015 Jun 1;115(11):1574-9. doi: 10.1016/j.amjcard.2015.02.059. Epub 2015 Mar 12. Incidence and risk factors of hemolysis after …

A year in the life of a cardiologist: an interview with Dr …

Dr Manoharan is the clinical lead for the TAVR programme in Northern Ireland and functions as a Clinical Proctor for the Medtronic CoreValve and the …

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Insurance Coverage and Clinical Trials. Federal law requires most health insurance plans to cover routine patient care costs in clinical … National …

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Transcatheter aortic valve replacement (TAVR) in patients with systemic autoimmune diseases. Fuentes-Alexandro S(1), Escarcega R, Garcia-Carrasco M …

Transcatheter versus surgical aortic-valve replacement in …

Transcatheter versus surgical aortic-valve replacement in high-risk patients. Smith CR(1), Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, …

Transapical Transcatheter Valve-in-Valve Implantation for …

Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Valve Bioprosthesis. … Transcatheter valve-in- valve implantation has been …

Echocardiography – Journals – NCBI

Echocardiography journal page at PubMed Journals. Published by Wiley-Blackwell

Transapical Transcatheter Valve-in-Valve Implantation for …

Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Valve Bioprosthesis. … Transcatheter valve-in- valve implantation has been …

Impact of Interaction of Diabetes Mellitus and Impaired …

Impact of Interaction of Diabetes Mellitus and Impaired Renal Function on Prognosis and the Incidence of Acute Kidney Injury in Patients Undergoing …

Frequency of and Prognostic Significance of Atrial …

Frequency of and Prognostic Significance of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation. Sannino A(1), …

Timing, predictive factors, and prognostic value of …

1. Circulation. 2012 Dec 18;126(25):3041-53. doi: 10.1161/CIRCULATIONAHA.112.110981. Epub 2012 Nov 13. Timing, predictive factors, and prognostic …

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accessgudid.nlm.nih.gov/devices/00643169368873

accessgudid – na (00643169368873)- custom pack cb8a42r 2pk tavr pack

Balloon expandable sheath for transfemoral aortic valve …

Balloon expandable sheath for transfemoral aortic valve implantation: a viable option for patients with challenging access. Dimitriadis Z(1), Scholtz …

Staged High-Risk Percutaneous Coronary Intervention with …

The management of concomitant obstructive coronary artery disease and severe aortic stenosis in poor surgical candidates is an evolving topic …

TAVR BMI – PubMed Result

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Aortic valve replacement: is porcine or bovine valve better?

Comment in Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):373-4. Interact Cardiovasc Thorac Surg. 2013 Mar;16(3):374. A best evidence topic in …

Can TAVR Make Me Smarter?

Author information: (1)Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, New Jersey; Cardiovascular …

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Transthoracic echocardiography guidance for TAVR under monitored anesthesia care. Sengupta PP, Wiley BM, Basnet S, Rajamanickman A, Kovacic JC …

Intravenous Adenosine-Based Fractional Flow Reserve in Pre …

1. J Invasive Cardiol. 2016 Sep;28(9):362-3. Intravenous Adenosine-Based Fractional Flow Reserve in Pre-TAVR Assessment of Severe AS: Finally Some …

Intraprocedural TAVR Annulus Sizing Using 3D TEE and the …

Intraprocedural TAVR Annulus Sizing Using 3D TEE and the “Turnaround Rule”. Wiley BM, Kovacic JC, Basnet S, Makoto A, Chaudhry FA, Kini AS, Sharma SK …

Transcatheter versus surgical aortic-valve replacement in …

Transcatheter versus surgical aortic-valve replacement in high-risk patients. Smith CR(1), Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, …

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Intravenous Adenosine-Based Fractional Flow Reserve in Pre …

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Postprocedural management of patients after transcatheter …

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diastolic dysfunction – PubMed – NCBI

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CABG: a Superior Revascularization Modality to PCI in Patients with poor LVF, Multivessel disease and Diabetes, Similar Risk of Stroke between 31 days and 5 years, post intervention

Reporter: Aviva Lev-Ari, PhD, RN

 

Lancet Study, 2/2018

Interpretation

CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies.

JACC Study, 7/2018

CONCLUSIONS

This individual patient-data pooled analysis demonstrates that 5-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and 5 years. The greater risk of stroke after CABG compared with PCI was confined to patients with multivessel disease and diabetes. Five-year mortality was markedly higher for patients experiencing a stroke within 30 days after revascularization.

European Journal of Cardiothoracic Surgery Study, 6/2018

CONCLUSIONS

Despite a longer length of hospital stay, patients with impaired LVF requiring intervention for coronary artery disease experienced a greater post-procedural survival benefit if they received CABG compared to PCI. We have demonstrated this at 30 days, 90 days, 1 year, 3 years, 5 years and 8 years following revascularization. At present, CABG remains a superior revascularization modality to PCI in patients with poor LVF.

 

New Studies on Clinical Outcomes from two Revascularization Strategies: CABG and PCI

 

J Am Coll Cardiol. 2018 Jul 24;72(4):386-398. doi: 10.1016/j.jacc.2018.04.071.

Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.

Abstract

BACKGROUND:

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI.

OBJECTIVES:

This study sought to compare rates of stroke after CABG and PCI and the impact of procedural stroke on long-term mortality.

METHODS:

We performed a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents; ERACI II (Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS (Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine, Angioplasty, or Surgery Study) (n = 408), SoS (Stent or Surgery) trial (n = 988), SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial (n = 1,800), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) trial (n = 600), FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900), VA CARDS (Coronary Artery Revascularization in Diabetes) (n = 198), BEST (Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease) (n = 880), NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trial (n = 1,184), and EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial (n = 1,905). The 30-day and 5-year stroke rates were compared between CABG and PCI using a random effects Cox proportional hazards model, stratified by trial. The impact of stroke on 5-year mortality was explored.

RESULTS:

The analysis included 11,518 patients randomly assigned to PCI (n = 5,753) or CABG (n = 5,765) with a mean follow-up of 3.8 ± 1.4 years during which a total of 293 strokes occurred. At 30 days, the rate of stroke was 0.4% after PCI and 1.1% after CABG (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.20 to 0.53; p < 0.001). At 5-year follow-up, stroke remained significantly lower after PCI than after CABG (2.6% vs. 3.2%; HR: 0.77; 95% CI: 0.61 to 0.97; p = 0.027). Rates of stroke between 31 days and 5 years were comparable: 2.2% after PCI versus 2.1% after CABG (HR: 1.05; 95% CI: 0.80 to 1.38; p = 0.72). No significant interactions between treatment and baseline clinical or angiographic variables for the 5-year rate of stroke were present, except for diabetic patients (PCI: 2.6% vs. CABG: 4.9%) and nondiabetic patients (PCI: 2.6% vs. CABG: 2.4%) (p for interaction = 0.004). Patients who experienced a stroke within 30 days of the procedure had significantly higher 5-year mortality versus those without a stroke, both after PCI (45.7% vs. 11.1%, p < 0.001) and CABG (41.5% vs. 8.9%, p < 0.001).

CONCLUSIONS:

This individual patient-data pooled analysis demonstrates that 5-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and 5 years. The greater risk of stroke after CABG compared with PCI was confined to patients with multivessel disease and diabetes. Five-year mortality was markedly higher for patients experiencing a stroke within 30 days after revascularization.

KEYWORDS:

coronary artery bypass graft; left main; mortality; multivessel; percutaneous coronary intervention; stenting; stroke

PMID:
30025574
DOI:
10.1016/j.jacc.2018.04.071

 

Lancet Study

Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF, Stables RH, Stone GW, Serruys PW, Kappetein AP. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018 Feb 22 [Epub ahead of print]. doi: 10.1016/S0140-6736(18)30423-9. PMID: 29478841

Summary

Background

Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies.

Methods

We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics.

Findings

We included 11 randomised trials involving 11 518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3·8 years (SD 1·4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26·0 (SD 9·5), with 1798 (22·1%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11·2% after PCI and 9·2% after CABG (hazard ratio [HR] 1·20, 95% CI 1·06–1·37; p=0·0038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11·5% after PCI vs 8·9% after CABG; HR 1·28, 95% CI 1·09–1·49; p=0·0019), including in those with diabetes (15·5% vs 10·0%; 1·48, 1·19–1·84; p=0·0004), but not in those without diabetes (8·7% vs 8·0%; 1·08, 0·86–1·36; p=0·49). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10·7% after PCI vs 10·5% after CABG; 1·07, 0·87–1·33; p=0·52), regardless of diabetes status and SYNTAX score.

Interpretation

CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies.

SOURCE

European Journal of Cardiothoracic Surgery Study, 6/2018

 

Eur J Cardiothorac Surg. 2018 Jun 22. doi: 10.1093/ejcts/ezy236. [Epub ahead of print]

Comparison of the survival between coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with poor left ventricular function (ejection fraction <30%): a propensity-matched analysis.

Abstract

OBJECTIVES:

Existing evidence comparing the outcomes of coronary artery bypass graft (CABG) surgery versus percutaneous coronary intervention (PCI) in patients with poor left ventricular function (LVF) is sparse and flawed. This is largely due to patients with poor LVF being underrepresented in major research trials and the outdated nature of some studies that do not consider drug-eluting stent PCI.

METHODS:

Following strict inclusion criteria, 717 patients who underwent revascularization by CABG or PCI between 2002 and 2015 were enrolled. All patients had poor LVF (defined by ejection fraction <30%). By employing a propensity score analysis, 134 suitable matches (67 CABG and 67 PCI) were identified. Several outcomes were evaluated, in the matched population, using data extracted from national registry databases.

RESULTS:

CABG patients required a longer length of hospital stay post-revascularization compared to PCI in the propensity-matched population, 7 days (lower-upper quartile; 6-12) and 2 days (lower-upper quartile; 1-6), respectively (Mood’s median test, P = 0.001). Stratified Cox-regression proportional-hazards analysis of the propensity-matched population found that PCI patients experienced a higher adjusted 8-year mortality rate (hazard ratio 3.291, 95% confidence interval 1.776-6.101; P < 0.001). This trend was consistent amongst urgent cases of revascularization: patients with 3 or more vessels with coronary artery disease and patients where complete revascularization was achieved. Although sub-analyses found no difference between survival distributions of on-pump versus off-pump CABG (log-rank P = 0.726), both modes of CABG were superior to PCI (stratified log-rank P = 0.002).

CONCLUSIONS:

Despite a longer length of hospital stay, patients with impaired LVF requiring intervention for coronary artery disease experienced a greater post-procedural survival benefit if they received CABG compared to PCI. We have demonstrated this at 30 days, 90 days, 1 year, 3 years, 5 years and 8 years following revascularization. At present, CABG remains a superior revascularization modality to PCI in patients with poor LVF.

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Omega-3 fats Supplements Effect on Cardiovascular Health: EPA and DHA has little or no effect on Mortality or Cardiovascular Health

Reporter: Aviva Lev-Ari, PhD, RN

 

Cochrane Database Syst Rev. 2018 Jul 18;7:CD003177. doi: 10.1002/14651858.CD003177.pub3. [Epub ahead of print]

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.

Abstract

BACKGROUND:

Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich foods, and sometimes supplementation, but recent trials have not confirmed this.

OBJECTIVES:

To assess effects of increased intake of fish- and plant-based omega-3 for all-cause mortality, cardiovascular (CVD) events, adiposity and lipids.

SEARCH METHODS:

We searched CENTRAL, MEDLINE and Embase to April 2017, plus ClinicalTrials.gov and World Health Organization International Clinical Trials Registry to September 2016, with no language restrictions. We handsearched systematic review references and bibliographies and contacted authors.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs) that lasted at least 12 months and compared supplementation and/or advice to increase LCn3 or ALA intake versus usual or lower intake.

DATA COLLECTION AND ANALYSIS:

Two review authors independently assessed studies for inclusion, extracted data and assessed validity. We performed separate random-effects meta-analysis for ALA and LCn3 interventions, and assessed dose-response relationships through meta-regression.

MAIN RESULTS:

We included 79 RCTs (112,059 participants) in this review update and found that 25 were at low summary risk of bias. Trials were of 12 to 72 months’ duration and included adults at varying cardiovascular risk, mainly in high-income countries. Most studies assessed LCn3 supplementation with capsules, but some used LCn3- or ALA-rich or enriched foods or dietary advice compared to placebo or usual diet.Meta-analysis and sensitivity analyses suggested little or no effect of increasing LCn3 on all-cause mortality (RR 0.98, 95% CI 0.90 to 1.03, 92,653 participants; 8189 deaths in 39 trials, high-quality evidence), cardiovascular mortality (RR 0.95, 95% CI 0.87 to 1.03, 67,772 participants; 4544 CVD deaths in 25 RCTs), cardiovascular events (RR 0.99, 95% CI 0.94 to 1.04, 90,378 participants; 14,737 people experienced events in 38 trials, high-quality evidence), coronary heart disease (CHD) mortality (RR 0.93, 95% CI 0.79 to 1.09, 73,491 participants; 1596 CHD deaths in 21 RCTs), stroke (RR 1.06, 95% CI 0.96 to 1.16, 89,358 participants; 1822 strokes in 28 trials) or arrhythmia (RR 0.97, 95% CI 0.90 to 1.05, 53,796 participants; 3788 people experienced arrhythmia in 28 RCTs). There was a suggestion that LCn3 reduced CHD events (RR 0.93, 95% CI 0.88 to 0.97, 84,301 participants; 5469 people experienced CHD events in 28 RCTs); however, this was not maintained in sensitivity analyses – LCn3 probably makes little or no difference to CHD event risk. All evidence was of moderate GRADE quality, except as noted.Increasing ALA intake probably makes little or no difference to all-cause mortality (RR 1.01, 95% CI 0.84 to 1.20, 19,327 participants; 459 deaths, 5 RCTs),cardiovascular mortality (RR 0.96, 95% CI 0.74 to 1.25, 18,619 participants; 219 cardiovascular deaths, 4 RCTs), and it may make little or no difference to CHD events (RR 1.00, 95% CI 0.80 to 1.22, 19,061 participants, 397 CHD events, 4 RCTs, low-quality evidence). However, increased ALA may slightly reduce risk of cardiovascular events (from 4.8% to 4.7%, RR 0.95, 95% CI 0.83 to 1.07, 19,327 participants; 884 CVD events, 5 RCTs, low-quality evidence), and probably reduces risk of CHD mortality (1.1% to 1.0%, RR 0.95, 95% CI 0.72 to 1.26, 18,353 participants; 193 CHD deaths, 3 RCTs), and arrhythmia (3.3% to 2.6%, RR 0.79, 95% CI 0.57 to 1.10, 4,837 participants; 141 events, 1 RCT). Effects on stroke are unclear.Sensitivity analysis retaining only trials at low summary risk of bias moved effect sizes towards the null (RR 1.0) for all LCn3 primary outcomes except arrhythmias, but for most ALA outcomes, effect sizes moved to suggest protection. LCn3 funnel plots suggested that adding in missing studies/results would move effect sizes towards null for most primary outcomes. There were no dose or duration effects in subgrouping or meta-regression.There was no evidence that increasing LCn3 or ALA altered serious adverse events, adiposity or lipids, although LCn3 slightly reduced triglycerides and increased HDL. ALA probably reduces HDL (high- or moderate-quality evidence).

AUTHORS’ CONCLUSIONS:

This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia.

PMID:
30019766
DOI:
10.1002/14651858.CD003177.pub3

SOURCE

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Stanford University researchers have developed a scanner that unites optical, radioluminescence, and photoacoustic imaging to evaluate for Thin-Cap Fibro Atheroma (TCFA)

Reporter: Aviva Lev-Ari, RN

 

Early diagnosis and treatment could save lives by preventing the progression, and subsequent rupture, of these plaques. That is precisely why researchers designed the Circumferential-Intravascular-Radioluminescence-Photoacoustic-Imaging (CIRPI) system, which allows not just high-acuity optical imaging via beta-sensitive probe, but also radioluminescent marking inside the artery to determine the extent of inflammation. Photoacoustic imaging also provides information about the often-complex biological makeup of the plaques (how much is calcified or comprised of cholesterol or triglycerides).

SOURCE

https://www.mdtmag.com/news/2017/06/pet-imaging-atherosclerosis-reveals-risk-plaque-rupture?cmpid=horizontalcontent

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Two Classes of Antithrombotic Drugs: Anticoagulants and Antiplatelet drugs

Reporter: Aviva Lev-Ari, PhD, RN
These drugs are used to treat
  • strokes,
  • myocardial infarctions,
  • pulmonary embolisms,
  • disseminated intravascular coagulation (DIC) and
  • deep vein thrombosis (DVT)
— all potentially life-threatening conditions.
THERAPEUTIC STRATEGIES
• Degrade fibrinogen/fibrin (fibrinolytic agents)
GOAL: eliminate formed clots
• Inhibit clotting mechanism (anticoagulants)
GOAL: prevent progression of thrombosis
• Interfere either with platelet adhesion and/or aggregation (antiplatelet drugs)
GOAL: prevent initial clot formation
Antithrombotic therapy has had an enormous impact in several significant ways.
  • Heparin has made bypass surgery and dialysis possible by blocking clotting in external tubing.
  • Antithrombotic therapy has reduced the risk of blood clots in leg veins (also known as deep-vein thrombosis or DVT), a condition that can lead to death from pulmonary embolism (a clot that blocks an artery to the lungs) by more than 70 percent. And most importantly,
  • it has markedly reduced death from heart attacks, the risk of stroke in people with heart irregularities (atrial fibrillation), and the risk of major stroke in patients with mini-strokes.

Antithrombotic Therapy

This article was published in December 2008 as part of the special ASH anniversary brochure, 50 Years in Hematology: Research That Revolutionized Patient Care.

Normally, blood flows through our arteries and veins smoothly and efficiently, but if a clot, or thrombus, blocks the smooth flow of blood, the result – called thrombosis – can be serious and even cause death. Diseases arising from clots in blood vessels include heart attack and stroke, among others. These disorders collectively are the most common cause of death and disability in the developed world. We now have an array of drugs that can be used to prevent and treat thrombosis – and there are more on the way – but this was not always the case.

Classes of Antithrombotic Drugs

Image Source: http://www.hematology.org/About/History/50-Years/1523.aspx

The most important components of a thrombus are fibrin and platelets. Fibrin is a protein that forms a mesh that traps red blood cells, while platelets, a type of blood cell, form clumps that add to the mass of the thrombus. Both fibrin and platelets stabilize the thrombus and prevent it from falling apart. Fibrin is the more important component of clots that form in veins, and platelets are the more important component of clots that form in arteries where they can cause heart attacks and strokes by blocking the flow of blood in the heart and brain, respectively, although fibrin plays an important role in arterial thrombosis as well.

There are two classes of antithrombotic drugs: anticoagulants and antiplatelet drugs. Anticoagulants slow down clotting, thereby reducing fibrin formation and preventing clots from forming and growing. Antiplatelet agents prevent platelets from clumping and also prevent clots from forming and growing.

Anticoagulant Drugs

The anticoagulants heparin and dicumarol were discovered by chance, long before we understood how they worked. Heparin was first discovered in 1916 by a medical student at The Johns Hopkins University who was investigating a clotting product from extracts of dog liver and heart. In 1939, dicumarol (the precursor to warfarin) was extracted by a biochemist at the University of Wisconsin from moldy clover brought to him by a farmer whose prize bull had bled to death after eating the clover.

Both of these anticoagulants have been used effectively to prevent clots since 1940. These drugs produce a highly variable anticoagulant effect in patients, requiring their effect to be measured by special blood tests and their dose adjusted according to the results. Heparin acts immediately and is given intravenously (through the veins). Warfarin is swallowed in tablet form, but its anticoagulant effect is delayed for days. Therefore, until recently, patients requiring anticoagulants who were admitted to a hospital were started on a heparin infusion and were then discharged from the hospital after five to seven days on warfarin.

In the 1970s, three different groups of researchers in Stockholm, London, and Hamilton, Ontario, began work on low-molecular-weight heparin (LMWH). LMWH is produced by chemically splitting heparin into one-third of its original size. It has fewer side effects than heparin and produces a more predictable anticoagulant response. By the mid 1980s, LMWH preparations were being tested in clinical trials, and they have now replaced heparin for most indications. Because LMWH is injected subcutaneously (under the skin) in a fixed dose without the need for anticoagulant monitoring, patients can now be treated at home instead of at the hospital.

With the biotechnology revolution has come genetically engineered “designer” anticoagulant molecules that target specific clotting enzymes. Anti-clotting substances and their DNA were also extracted from an array of exotic creatures (ticks, leeches, snakes, and vampire bats) and converted into drugs by chemical synthesis or genetic engineering. Structural chemists next began to fabricate small molecules designed to fit into the active component of clotting enzymes, like a key into a lock.

The first successful synthetic anticoagulants were fondaparinux and bivalirudin. Bivalirudin, a synthetic molecule based on the structure of hirudin (the anti-clotting substance found in leeches), is an effective treatment for patients with heart attacks. Fondaparinux is a small molecule whose structure is based on the active component of the much larger LMWH and heparin molecules. It has advantages over LMWH and heparin and has recently been approved by the FDA. Newer designer drugs that target single clotting factors and that can be taken by mouth are undergoing clinical testing. If successful, we will have safer and more convenient replacements for warfarin, the only oral anticoagulant available for more than 60 years.

Antiplatelet Drugs

Blood platelets are inactive until damage to blood vessels or blood coagulation causes them to explode into sticky irregular cells that clump together and form a thrombus. The first antiplatelet drug was aspirin, which has been used to relieve pain for more than 100 years. In the mid-1960s, scientists showed that aspirin prevented platelets from clumping, and subsequent clinical trials showed that it reduces the risk of stroke and heart attack. In 1980, researchers showed that aspirin in very low doses (much lower than that required to relieve a headache) blocked the production of a chemical in platelets that is required for platelet clumping. During that time, better understanding of the process of platelet clumping allowed the development of designer antiplatelet drugs directed at specific targets. We now have more potent drugs, such as clopidogrel, dipyridamole, and abciximab. These drugs are used with aspirin and effectively prevent heart attack and stroke; they also prolong the lives of patients who have already had a heart attack.

SOURCE 
Anticoagulation Drugs:
  • heparin (FONDAPARINUX HEPARIN (Calciparine, Hepathrom, Lipo-Hepin, Liquaemin, Panheprin)
  • warfarin – 4-HYDROXYCOUMARIN (Coumadin) WARFARIN (Athrombin-K, Panwarfin)
  • rivaroxaban (Xarelto)
  • dabigatran (Pradaxa)
  • apixaban (Eliquis)
  • edoxaban (Savaysa)
  • enoxaparin (Lovenox)
  • fondaparinux (Arixtra)
  • ARGATROBAN BIVALIRUDIN (Angiomax)
  • DALTEPARIN (Fragmin)
  • DROTRECOGIN ALFA (ACTIVATED PROTEIN C) (Xigris)
  • HIRUDIN (Desirudin)
  • LEPIRUDIN (Refludan)
  • XIMELAGATRAN (Exanta)

ANTIDOTES

  • PHYTONADIONE (Vitamin K1)
  • PROTAMINE SULFATE AMINOCAPROIC ACID (EACA) (generic, Amicar) (in bleeding disorders)
Antiplatelet Drugs
  • ACETYL SALICYLIC ACID (aspirin) 
  • clopidogrel (Plavix)
  • dipyridamole (Persantine)
  • abciximab (Centocor)
  • EPTIFIBATIDE (Integrilin)
  • TICLOPIDINE (Ticlid)
  • TIROFIBAN (Aggrastat)

THROMBOLYTICS

  1. ANISTREPLASE (APSAC; Eminase)
  2. STREPTOKINASE (Streptase, Kabikinase)
  3. TISSUE PLASMINOGEN ACTIVATORS (tPAs):
  • ALTEPLASE (Activase),
  • RETEPLASE (Retavase),
  • TENECTEPLASE (TNKase)
  • UROKINASE (Abbokinase)

Fibrinolytic Drugs

Fibrinolytic therapy is used in selected patients with venous thromboembolism. For example, patients with massive or submassive PE can benefit from systemic or catheter-directed fibrinolytic therapy. The latter can also be used as an adjunct to anticoagulants for treatment of patients with extensive iliofemoral-vein thrombosis.

Arterial and venous thrombi are composed of platelets and fibrin, but the proportions differ.

  • Arterial thrombi are rich in platelets because of the high shear in the injured arteries. In contrast,
  • venous thrombi, which form under low shear conditions, contain relatively few platelets and are predominantly composed of fibrin and trapped red cells.
  • Because of the predominance of platelets, arterial thrombi appear white, whereas venous thrombi are red in color, reflecting the trapped red cells.

SOURCE

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 Cholesterol Lowering Novel PCSK9 drugs: Praluent [Sanofi and Regeneron] vs Repatha [Amgen] – which drug cuts CV risks enough to make it cost-effective?

Reporter: Aviva Lev-Ari, PhD, RN

 

Did Amgen’s Repatha cut CV risks enough to make it cost-effective? Analysts say no

Sanofi, Regeneron’s Praluent pulls off PCSK9 coup with 29% cut to death risks in most vulnerable patients
SEE our curations on PCSK9 drugs:

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