Risk Stratification in Asymptomatic Aortic Stenosis

2012 ◽  
Vol 8 (2) ◽  
pp. 120 ◽  
Author(s):  
Raluca Dulgheru ◽  
Sara Hana Weisz ◽  
Julien Magne ◽  
Patrizio Lancellotti ◽  
◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Elective Surgery ◽  
Clinical Importance ◽  
Developed Countries ◽  
Predictors Of Outcome ◽  
Asymptomatic Patients ◽  
Selection Of Patients ◽  
Selection Of

Aortic stenosis is now the most frequent valvular heart disease in developed countries with a steadily increase in prevalence. The necessity of surgery in symptomatic patients is well established. However, the need for surgery in asymptomatic patients remains controversial. The identification of several factors (predictors of outcome) that may help selection of patients who are most likely to benefit from early elective surgery is challenging and of clinical importance.

Valvular Heart Disease - Part II

2021 ◽  
Author(s):  
Miriam S. Jacob ◽  
Brian P Griffin
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Valvular Heart Disease ◽  
Mitral Valve Prolapse ◽  
Developed Countries ◽  
Cardiac Morbidity ◽  
Mechanical Prostheses

Valvular heart disease is an important cause of cardiac morbidity in developed countries despite a decline in the prevalence of rheumatic disease in those countries. This chapter discusses the many etiologies of valvular heart disease and presents methods for assessment and management. Specific valvular lesions discussed include mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, aortic regurgitation, and tricuspid and pulmonary disease. The section on tricuspid disease includes a discussion of mechanical prostheses (ball-in-cage and tilting-disk) and biologic prostheses (xenografts, allografts, and autografts) and their complications.  This review contains 5 figures, 9 tables, and 53 references. Keywords: Valvular heart disease, stenosis, regurgitation, mitral regurgitation, mitral valve prolapse (MVP), aortic stenosis, congenital bicuspid valve, senile valvular calcification, aortic regurgitation, chordae or papillary muscles

scholarly journals A new model to prioritize waiting lists for elective surgery under the COVID-19 pandemic pressure

2020 ◽  
Author(s):  
Roberto Valente ◽  
Stefano Di Domenico ◽  
Matteo Mascherini ◽  
Gregorio Santori ◽  
Francesco Papadia ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Waiting Lists ◽  
Waiting List ◽  
Service Capacity ◽  
Rapid Disease Progression ◽  
Prioritization Method ◽  
Access To Surgery ◽  
Selection Of Patients ◽  
Center Research ◽  
Selection Of

AbstractThe COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, forcing extreme selection of patients most in need. Our study assesses the SWALIS- 2020 model ability to prioritize access to surgery during the highest viral outbreak peaks.A 2020 March - May feasibility-pilot study tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Surgical Departments referred for urgent elective patients were prioritized by a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). We have studied the model’s applicability and its ability to prioritize patients by monitoring waiting list and service performance. https://www.isrctn.com/ISRCTN11384058.Following the feasibility study (N=55 patients), 240 referrals were evaluated in 4 weeks without major criticalities (M/F=73/167, Age=68.7 +/- 14.0). Waiting lists were prioritized and monitored. The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88.7 +/- 45.2 at week 1 and then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153.29 +/- 103.52) vs. A1 (97.24 +/- 107.93) (p <0.001), and A3 vs. A2 (88.05 +/- 77.51) (p <0.001). 222 patients underwent surgery, without related complications or delayed/failed discharges.The pathway has selected the very few patients with the greatest need, even with +30% capacity weekly modifications, managing active and backlog waiting lists. We are looking for collaboration for multi-center research.

Aortic stenosis in adults. Evaluation of diagnostic criteria in the selection of patients for surgical treatment

1962 ◽  
Vol 64 (5) ◽  
pp. 625-630 ◽  
Author(s):  
Patrick A. Gorman ◽  
Juan B. Calatayud ◽  
R.F. Patrick Cronin ◽  
E.A. Stewart Reid ◽  
Harold J. Scott
Keyword(s):  
Surgical Treatment ◽  
Aortic Stenosis ◽  
Diagnostic Criteria ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals Current Challenges in the Management of Infective Endocarditis

2021 ◽  
Vol 8 ◽  
Author(s):  
Guillermo Cuervo ◽  
Francesc Escrihuela-Vidal ◽  
Carlota Gudiol ◽  
Jordi Carratalà
Keyword(s):  
Infective Endocarditis ◽  
Developed Countries ◽  
Diagnostic Tools ◽  
Hospital Treatment ◽  
Oral Antibiotic ◽  
Close Collaboration ◽  
Epidemiological Changes ◽  
Selection Of Patients ◽  
Selection Of ◽  
Overall Mortality

Infective endocarditis is a relatively rare, but deadly cause of sepsis, with an overall mortality ranging from 20 to 25% in most series. Although the classic clinical classification into syndromes of acute or subacute endocarditis have not completely lost their usefulness, current clinical forms have changed according to the profound epidemiological changes observed in developed countries. In this review, we aim to address the changing epidemiology of endocarditis, several recent advances in the understanding of the pathophysiology of endocarditis and endocarditis-triggered sepsis, new useful diagnostic tools as well as current concepts in the medical and surgical management of this disease. Given its complexity, the management of infective endocarditis requires the close collaboration of multidisciplinary endocarditis teams that must decide on the diagnostic approach; the appropriate initial treatment in the critical phase; the detection of patients needing surgery and the timing of this intervention; and finally the accurate selection of patients for out-of-hospital treatment, either at home hospitalization or with oral antibiotic treatment.

Incidental vs. clinical diagnosis of renal cell carcinoma (RCC): Population, treatment and outcome in a cohort of 828 patients followed at Instituto Oncológico Henry Moore (IOHM).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16075-e16075
Author(s):  
Dario Niewiadomski ◽  
Claudia Lorena Acuna ◽  
Eduardo L. Morgenfeld ◽  
Flavio Tognelli ◽  
Leonardo Smolje ◽  
...  
Keyword(s):  
Epidemiological Data ◽  
Developed Countries ◽  
Early Stages ◽  
Group A ◽  
Diagnosis Of Cancer ◽  
Group B ◽  
Selection Of Patients ◽  
Icd10 Code ◽  
Selection Of

e16075 Background: For the past three decades, it has been observed in developed countries an increase in the incidence of RCC, at the expense of small tumors incidentally found. This study compares the epidemiology, treatment and evolution of the patients (pt) with incidental RCC (Group A) or clinical RCC (Group B). Methods: Between 1/1/2001 and 11/30/2016, 29,440 new pt with histological diagnosis of cancer were incorporated to the IOHM database. We selected all those coded under the WHO ICD10 code C64. The medical records were reviewed, registering the epidemiological data, treatments and evolution of each patient Results: We identified 828 pt out of 29,940 pt (2.8%) who met the inclusion criteria. Group A = 507 pt (61%) and Group B = 321 pt (39%). The table below shows the characteristics of both groups. Conclusions: 1) In this cohort the incidental diagnosis of RCC represented 60% of the cases and correlated with early stages and less aggressive tumors. 2) The appropriate selection of patients allowed partial nephrectomies in 103/828 Pt. (12% of the cases). 3) With a median follow-up of 30 months the survival rate of this population exceeded 90% in the early stages and was close to 50% in advanced cases. [Table: see text]

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