TCTAP A-117 Improvement of New York Heart Association (NYHA) Status in High Risk Patients with Severe Mitral Incompetence Following Percutaneous MitraClip Procedure

Background The performance of traditional scores is significantly limited to predict mortality in high-risk cardiac surgery. The aim of this study was to compare the performance of STS, ESII and HiriSCORE models in predicting mortality in high-risk patients undergoing CABG. Methods Cross-sectional analysis in the international prospective database of high-risk patients: HiriSCORE project. We evaluated 248 patients with STS or ESII (5–10%) undergoing CABG in 8 hospitals in Brazil and China. The main outcome was mortality, defined as all deaths occurred during the hospitalization in which the operation was performed, even after 30 days. Five variables were selected as predictors of mortality in this cohort of patients. The model’s performance was evaluated through the calibration-in-the-large and the receiver operating curve (ROC) tests. Results The mean age was 69.90±9.45, with 52.02% being female, 25% of the patients were on New York Heart Association (NYHA) class IV and 49.6% had Canadian Cardiovascular Society (CCS) class 4 angina, and 85.5% had urgency or emergency status. The mortality observed in the sample was 13.31%. The HiriSCORE model showed better calibration (15.0%) compared to ESII (6.6%) and the STS model (2.0%). In the ROC curve, the HiriSCORE model showed better accuracy (ROC = 0.74) than the traditional models STS (ROC = 0.67) and ESII (ROC = 0.50). Conclusion Traditional models were inadequate to predict mortality of high-risk patients undergoing CABG. However, the HiriSCORE model was simple and accurate to predict mortality in high-risk patients.

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Enhanced American College of Cardiology/American Heart Association Strategy for Prevention of Sudden Cardiac Death in High-Risk Patients With Hypertrophic Cardiomyopathy

JAMA Cardiology ◽

10.1001/jamacardio.2019.1391 ◽

2019 ◽

Vol 4 (7) ◽

pp. 644 ◽

Cited By ~ 58

Author(s):

Martin S. Maron ◽

Ethan J. Rowin ◽

Benjamin S. Wessler ◽

Paula J. Mooney ◽

Amber Fatima ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

High Risk ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

High Risk Patients ◽

Association Strategy ◽

Risk Patients

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Outcomes after the MitraClip Procedure in Patients at Very High Risk for Conventional Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000571 ◽

2018 ◽

Vol 13 (6) ◽

pp. 433-437

Author(s):

Joshua L. Manghelli ◽

Daniel I. Carter ◽

Ali J. Khiabani ◽

Hersh S. Maniar ◽

Ralph J. Damiano ◽

...

Keyword(s):

New York ◽

High Risk ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Heart Association ◽

Mitral Valve Surgery ◽

Risk Of Mortality ◽

New York Heart Association ◽

Predicted Risk

Objective Approximately 50% of patients with severe symptomatic mitral regurgitation are deemed too high risk for surgery. The MitraClip procedure is a viable option for this population. Our goal was to assess outcomes and survival of patients who underwent the MitraClip procedure at an institution where mitral valve surgery is routinely performed. Methods A retrospective study of patients undergoing the MitraClip procedure was performed. Baseline characteristics, perioperative outcomes, and follow-up echocardiographic and clinical outcomes were examined. Primary end point was survival. Secondary end points included technical failure (residual 3/4+ mitral regurgitation), reoperation, New York Heart Association symptoms, 30-day mortality, and other clinical outcomes. Predictors of mortality were determined using multivariable regression analysis. Results Fifty consecutive patients underwent the MitraClip procedure during the 4-year period. The average age was 83, the Society of Thoracic Surgeons predicted risk of mortality mean was 9.4%, 88% (44/50) had New York Heart Association III/IV symptoms, 86% (43/50) had 4+ mitral regurgitation, and 72% (36/50) had degenerative mitral disease etiology. Echocardiographic data (median [interquartile range] follow-up = 43 [26–392]) showed that 86% (43/50) of patients had 2+ or less mitral regurgitation. Sixty percent (24/40) had New York Heart Association I/II symptoms at last follow-up. Predictors of mortality were higher Society of Thoracic Surgeons predicted risk of mortality ( P = 0.042, hazard ratio = 1.098) and previous cardiac surgery ( P = 0.013, hazard ratio = 3.848). Survival at 1 and 2 years was 75% and 63%, respectively. Conclusions Many patients with mitral valve regurgitation who are high risk for open surgery can be treated with the MitraClip procedure. In our study, most patients (86%) had a technically successful operation and postoperative outcomes including survival were acceptable.

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The knowledge of undergraduate dental students and dentists about antibiotic prophylaxis in patients at risk for infective endocarditis

RGO - Revista Gaúcha de Odontologia ◽

10.1590/1981-863720200004620180006 ◽

2020 ◽

Vol 68 ◽

Author(s):

Ana Paula Silva GANGÁ ◽

Natália Bermond ARPINI ◽

Tatiany Pimentel FERREIRA ◽

Arlinda Lúcia Zocatelli CALENZANI ◽

Paula Sampaio de Mello ASSIS

Keyword(s):

Infective Endocarditis ◽

High Risk ◽

Heart Association ◽

Dental Students ◽

Mortality And Morbidity ◽

High Risk Patients ◽

Dental Procedures ◽

Patients At Risk ◽

Risk Patients ◽

Definition Of

ABSTRACT Infective Endocarditis (IE) is an infection of the endocardial surface of the heart that is caused by fungi, bacteria or viruses. The high mortality and morbidity rates of IE have encouraged the adoption of preventive strategies. This study investigated the knowledge on the prevention of IE among 2nd, 3rd and 4th-year undergraduate dental students at the Escola Superior São Francisco de Assis (ESFA) and among dentists working in the municipality of Santa Teresa, ES, Brazil. Objective: The rationale for this study was to identify the gaps in their knowledge and raise awareness on the topic. Methods: The study was previously approved by the Research Ethics Committee. The sample consisted of dental students who had completed the Pharmacology for Dentistry course at the ESFA, totaling 35 2nd-year students, 29 3rd-year students, and 36 4th-year students. Thirty dentists registered in the Regional Council of Dentistry of Espírito Santo state, who were working in the municipality of Santa Teresa, ES, Brazil, were also included. All participants were given a questionnaire containing six objective and four subjective questions to assess their knowledge regarding the definition of IE, high-risk patients, dental procedures known to cause bacteremia, recommended dosage regimens for high risk patients, and additional care in the assistance of these patients. The questionnaires’ responses were reviewed following the American Heart Association (AHA) guidelines for disease prevention published in 2007. Results: The analysis of the results revealed a low rate of correct responses among students and dentists. The questions with the lowest rate of correct responses were those addressing the identification of patients at high risk for heart conditions and the dental procedures known to cause bacteremia, with no significant differences between the four groups analyzed (P > 0.05). Third-year dental students presented a frequency of correct responses significantly lower than that of the other groups (P < 0.001), which did not differ from each other. To conclude, all participants demonstrated poor knowledge about the topic, particularly 3rd-year dental students. Conclusion: These results reinforce the need for informative measures to raise awareness and improve the quality of dental care provided to the population.

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EchoNavigator® technology facilitates transapical mitral paravalvular leak closure: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab190 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Igor Vyacheslavovich Buzaev ◽

Gulchachak Khalikova ◽

Vladimir Vyacheslavovich Plechev ◽

Eustaquio Maria Onorato

Keyword(s):

New York ◽

Past History ◽

Heart Association ◽

Mechanical Valve ◽

Fusion Imaging ◽

Paravalvular Leak ◽

Redo Surgery ◽

New York Heart Association ◽

Risk Patients ◽

Clinically Significant

Abstract Background Catheter-based closure has emerged as a less invasive alternative to surgery in high-risk patients with paravalvular leak (PVL) and clinically significant regurgitation with feasibility and efficacy demonstrated in multiple studies. Case summary A 72-year-old female with a past history of long-standing rheumatic heart disease underwent mechanical mitral valve replacement in 2008. Ten years later, redo surgery was performed due to a worsening mitral PVL and the leakage was closed by direct pledget-supported sutures, preserving the mechanical valve. She was recently admitted again for haemolytic anaemia and congestive heart failure (New York Heart Association Classes III–IV) due to a recurrent mitral PVL. We report our initial clinical experience using a novel software solution (EchoNavigator®-system) for intuitive guidance during a catheter-based transapical mitral PVL closure. Discussion Transapical mitral PVL closure with a specifically designed device demonstrated in our case to be a better option than redo surgery. Recently introduced fusion imaging modalities enhanced visualization of soft tissue anatomy and device location improving enormously the results of this challenging intervention.

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