Care of the patient after valve intervention

Heart ◽  
2022 ◽  
pp. heartjnl-2021-319767
Author(s):  
Lynne Martina Millar ◽  
Guy Lloyd ◽  
Sanjeev Bhattacharyya
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Medical Therapy ◽  
Evidence Base ◽  
Current Evidence ◽  
Healthy Weight ◽  
Childbearing Age ◽  
Transcatheter Aortic Valve ◽  
Current Evidence Base

This review aims to outline the current evidence base and guidance for care of patients post-valve intervention. Careful follow-up, optimisation of medical therapy, antithrombotics, reduction of cardiovascular risk factors and patient education can help improve patient outcomes and quality of life. Those with mechanical valves should receive lifelong anticoagulation with a vitamin K antagonist but in certain circumstances may benefit from additional antiplatelet therapy. Patients with surgical bioprosthetic valves, valve repairs and transcatheter aortic valve implantation also benefit from antithrombotic therapy. Additionally, guideline-directed medical therapy for coexistent heart failure should be optimised. Cardiovascular risk factors such as hyperlipidaemia, hypertension and diabetes should be treated in the same way as those without valve intervention. Patients should also be encouraged to exercise regularly, eat healthily and maintain a healthy weight. Currently, there is not enough evidence to support routine cardiac rehabilitation in individuals post-valve surgery or intervention but this may be considered on a case-by-case basis. Women of childbearing age should be counselled regarding future pregnancy and the optimal management of their valve disease in this context. Patients should be educated regarding meticulous oral health, be encouraged to see their dentist regularly and antibiotics should be considered for high-risk dental procedures. Evidence shows that patients post-valve intervention or surgery are best treated in a dedicated valve clinic where they can undergo clinical review and surveillance echocardiography, be provided with heart valve education and have access to the multidisciplinary valve team if needed.

scholarly journals Chapter III: Management of Cardiovascular Risk Factors and Medical Therapy

2011 ◽  
Vol 42 ◽  
pp. S33-S42 ◽  
Author(s):  
N. Diehm ◽  
J. Schmidli ◽  
C. Setacci ◽  
J.-B. Ricco ◽  
G. de Donato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Medical Therapy

scholarly journals ORBITA: What Goes Around, Comes Around… Or Does It?

2018 ◽  
Vol 13 (3) ◽  
pp. 135
Author(s):  
Matthew Jackson ◽  
Azfar Zaman ◽  
◽  
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Current Evidence ◽  
Placebo Control ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Artery Disease

Current guidelines recommend percutaneous coronary intervention (PCI) in patients with ongoing stable angina symptoms despite optimal medical therapy (OMT), although trials have shown no reduction in death or myocardial infarction. The recently published ORBITA trial compared OMT + PCI with OMT + ‘placebo’ PCI in patients with angina and single-vessel coronary artery disease (CAD), and found no significant difference in treadmill exercise time between the two groups after six weeks. The trial concluded that invasive procedures can be assessed with placebo control while numerous editorials interpreted the trial as showing that PCI has no role in the management of stable angina. However, the highly selected patient population, low ischaemic burden and level of symptoms and high proportion of nonflow-limiting stenoses on invasive physiological testing mean that, while ground-breaking in terms of its methodology, ORBITA does not add to the current evidence base supporting ischaemia-guided revascularisation if symptoms are not controlled on medical therapy alone.

scholarly journals Cardiovascular disease and COVID-19: les liaisons dangereuses

2020 ◽  
Vol 27 (10) ◽  
pp. 1017-1025 ◽  
Author(s):  
Andrea Barison ◽  
Alberto Aimo ◽  
Vincenzo Castiglione ◽  
Chiara Arzilli ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Effective Action ◽  
Current Evidence ◽  
Crucial Importance ◽  
Increased Risk ◽  
Practical Recommendations

Patients with cardiovascular risk factors or established cardiovascular disease have an increased risk of developing coronavirus disease 19 and have a worse outcome when infected, but translating this notion into effective action is challenging. At present it is unclear whether cardiovascular therapies may reduce the likelihood of infection, or improve the survival of infected patients. Given the crucial importance of this issue for clinical cardiologists and all specialists dealing with coronavirus disease 19, we tried to recapitulate the current evidence and provide some practical recommendations.

The treatment of hyperlipidaemia in postmenopausal women

2001 ◽  
Vol 7 (1) ◽  
pp. 28-32
Author(s):  
Mary Seed ◽  
R Mandeno ◽  
C Le Roux
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Ldl Cholesterol ◽  
Factor Vii ◽  
Current Evidence

This review summarises current evidence for therapeutic options for hyperlipidaemia in post menopausal women. The two situations in which treatment is recommended are: 1. Primary prevention, which requires assessment of total risk factors for coronary heart disease. a) Statins. AFCAPS/TEXCAPS is the only randomised controlled trial (RCT) to include women. Fewer coronary heart disease (CHD) events, but no difference in mortality was found. b) Hormone replacement therapy (HRT). While there are numerous reports of positive observational epidemiological studies for HRT, there are no completed RCTs. There is little evidence for statin use in women except for familial hypercholesterolaemia. HRT is therefore not only appropriate for its multiple effects on lipoproteins, vascular function and insulin sensitivity but also for prevention of osteoporosis. 2. Secondary prevention, to achieve target total and low density lipoprotein (LDL) cholesterol. a) Statins. The major measurable effect of these drugs is to reduce total and LDL cholesterol. In the RCTs 4S, CARE and LIPID, where 20% of subjects were female, CHD events, but neither CHD mortality nor total mortality were significantly reduced in women. b) HRT. Data available from two RCTs using conjugated equine oestrogens and medroxyprogesterone acetate show no benefit. Other studies of HRT have been observational and positive. The effects of treatment on lipoproteins with statins, HRT and the combination have been investigated. In secondary prevention for hyperlipidaemic women to achieve cholesterol <5 and LDL<3 mmol/L statins will be first choice, with HRT a possible addition for its other benefits on cardiovascular risk factors. Choice of HRT medication. The route of administration will affect specific risk factors, eg, oral oestrogen reduces Lp(a) and LDL, increases HDL, while the transdermal route is less effective at reducing Lp(a) and LDL but does not increase triglyceride. Both routes reduce fibrinogen, factor VII and adhesion molecules and improve blood flow. The choice of progestogen will also affect cardiovascular risk factors. The most important lipid risk factors in women are HDL, triglyceride and Lp(a). The risk associated with raised triglyceride and LDL is offset by high HDL. Thus, in women with risk factors in primary prevention, theoretically oral HRT with a non-androgenic progestogen is likely to be of most benefit. However, since long-term adherence to therapy is important in reducing cardiovascular risk, the individual's choice of route and type of HRT is paramount.

scholarly journals Contralateral Risk-Reducing Mastectomy: Review of Risk Factors and Risk-Reducing Strategies

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
N. N. Basu ◽  
L. Barr ◽  
G. L. Ross ◽  
D. G. Evans
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cost Effectiveness ◽  
Contralateral Breast Cancer ◽  
Evidence Base ◽  
Contralateral Breast ◽  
Current Evidence ◽  
Current Evidence Base ◽  
The Cost ◽  
Risk Reducing

Rates of contralateral risk-reducing mastectomy have increased substantially over the last decade. Surgical oncologists are often in the frontline, dealing with requests for this procedure. This paper reviews the current evidence base regarding contralateral breast cancer, assesses the various risk-reducing strategies, and evaluates the cost-effectiveness of contralateral risk-reducing mastectomy.

scholarly journals TAVI for Pure Native Aortic Regurgitation: Are We There Yet?

2019 ◽  
Vol 14 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Eduardo A Arias ◽  
Amit Bhan ◽  
Zhan Y Lim ◽  
Michael Mullen
Keyword(s):  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Evidence Base ◽  
Current Evidence ◽  
Native Valve ◽  
Off Label ◽  
The Past ◽  
Transcatheter Aortic Valve ◽  
Current Evidence Base ◽  
Valve Implantation

Treatment of degenerative aortic stenosis has been transformed by transcatheter aortic valve implantation (TAVI) over the past 10–15 years. The success of various technologies has led operators to attempt to broaden the indications, and many patients with native valve aortic regurgitation have been treated ‘off label’ with similar techniques. However, the alterations in the structure of the valve complex in pure native aortic regurgitation are distinct to those in degenerative aortic stenosis, and there are unique challenges to be overcome by percutaneous valves. Nevertheless some promise has been shown with both non-dedicated and dedicated devices. In this article, the authors explore some of these challenges and review the current evidence base for TAVI for aortic regurgitation.

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