scholarly journals 62 A comparison of percutaneous and surgical revascularisation strategies following an equipoise decision in a heart team meeting

2021 ◽  
Author(s):  
Jonathan Mailey ◽  
Mahmoud Ahmed ◽  
Michael Shahmohammadi ◽  
Conleth Murphy
Keyword(s):  
Heart Team ◽  
Team Meeting ◽  
Surgical Revascularisation

scholarly journals Outcomes of Patients Discussed at the Multidisciplinary “Heart Team” Meeting According to Treatment Allocation

2017 ◽  
Vol 26 ◽  
pp. S221
Author(s):  
C. Rea ◽  
P. Ruygrok ◽  
K. Sidhu ◽  
P. Nand ◽  
J. Stewart ◽  
...  
Keyword(s):  
Heart Team ◽  
Treatment Allocation ◽  
Team Meeting

Heart team. Когда привлекаем онколога?

2018 ◽  
Author(s):  
O.L. Barbarash
Keyword(s):  
Heart Team

В статье представлены современные взгляды на ведение пациентов с сердечно-сосудистой и онкологической патологиями. Обозначены наиболее спорные вопросы по проблемам подготовки пациентов с сердечно-сосудистой патологией к некардиологическим (онкологическим) оперативным вмешательствам. Обсуждены существующие ограничения в диагностике, профилактике и лечении кардиотоксичности химиотерапии при лечении злокачественных образований. Представлены перспективы научных исследований, направленных на оценку единых механизмов развития сердечно- сосудистых и онкологических заболеваний.

scholarly journals Valve-in-valve transcatheter aortic valve implantation with fracturing of a failed small surgical aortic bioprosthesis: a case report

2020 ◽  
Author(s):  
Matjaz Bunc ◽  
Miha Cercek ◽  
Tomaz Podlesnikar ◽  
Simon Terseglav ◽  
Klemen Steblovnik
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Ex Vivo ◽  
Bioprosthetic Valve ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.

scholarly journals Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
João Ferreira ◽  
Valdirene Gonçalves ◽  
Patrícia Marques-Alves ◽  
Rui Martins ◽  
Sílvia Monteiro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Atrial ◽  
Primary Outcome ◽  
Severe Aortic Stenosis ◽  
Heart Team ◽  
Pump Function ◽  
Volumetric Assessment ◽  
All Cause Mortality ◽  
Echocardiography Laboratory

Abstract Background Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. Methods We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. Results A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively). Conclusions In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.

scholarly journals Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation

2020 ◽  
Author(s):  
Ashvarya Mangla ◽  
Ameer Musa ◽  
Clifford J Kavinsky ◽  
Hussam S Suradi
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Heart Valve ◽  
Interatrial Septum ◽  
Chronic Obstructive ◽  
Mitral Valve Stenosis ◽  
Heart Team ◽  
Transcatheter Heart Valve ◽  
Valve Implantation ◽  
Buddy Wire

Abstract Background Transcatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum. Case summary We describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff ‘buddy wire’ anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home. Discussion Operators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff ‘buddy wire’ for support which avoids the need for more aggressive septal dilatation.

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