Multisociety (AATS, ACCF, SCAI, and STS) Expert Consensus Statement: Operator and Institutional Requirements for Transcatheter Valve Repair and Replacement, Part 1: Transcatheter Aortic Valve Replacement
Division of Cardiology, NorthShore University HealthSystem, Skokie Hospital, Skokie, Illinois 60076, USA.Journal of the American College of Cardiology (Impact Factor: 15.34). 02/2012; 59(22):2028-42. DOI: 10.1016/j.jacc.2012.02.016
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ABSTRACT: Transcatheter aortic valve replacement (TAVR) is performed with increasing frequency in the United States since Food and Drug Administration approval in 2011. The procedure involves the replacement of a severely stenosed native or bioprosthetic aortic valve with a specially constructed valvular prosthesis that is mounted onto a stent, without the use of cardiopulmonary bypass and the complications of a major open surgical procedure. TAVR has been performed mostly in elderly patients with multiple comorbidities or who have undergone previous cardiac surgery. The most commonly used access routes are the femoral artery (transfemoral) or the cardiac apex (transapical), but the transaortic and transubclavian approaches are also used with varying frequency. Conscious sedation may be used in patients undergoing transfemoral TAVR, but the use of general anesthesia has not been shown to carry greater risk and permits the use of transesophageal echocardiography to assist in valve positioning and diagnose complications. Cardiovascular instability during TAVR is relatively common, necessitating invasive monitoring and frequent use of vasoactive medications. Complications of the procedure are still relatively common and the most frequent is vascular injury to the access sites or the aorta. Cardiovascular collapse may be the result of major hemorrhage pericardial effusion with tamponade or coronary occlusion due to incorrect valve placement. Persistent hypotension, myocardial stunning, or injury requiring open surgical intervention may necessitate the use of cardiopulmonary bypass, the facilities for which should always be immediately available. Ongoing and planned trials comparing conventional surgery with TAVR in lower risk and younger patients should determine the place of TAVR in the medium- to long-term future.Anesthesia & Analgesia 10/2014; 119(4):784-798. DOI:10.1213/ANE.0000000000000400 · 3.42 Impact Factor
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ABSTRACT: New and effective minimally-invasive treatments for coronary artery and structural heart disease are emerging at an accelerating rate. Cardiac surgery, traditionally the gold standard treatment for most of these conditions, is no longer the immediate choice for discerning patients, attending physicians and healthcare funders. These factors when combined with pace of technological advances mean that cardiac surgery is undergoing a period of change. In this article, we consider how the transition from historical generalist-cardiologist-cardiac surgeon patients flows to more integrated patient specific care. Specifically, we will discuss how effective transition will require awareness of the drivers for change, models of best practice from other specialties and the potential benefits that this may have for patients, doctors and providers. To illustrate contemporary practice, we present a typical day in 2015 for our cardiac surgery teams: ‘We started out the day at the 06:30 with our weekly multidisciplinary heart failure/ventricular assist/transplant meeting to review the current inpatient and outpatient consults, the postoperative left ventricular assist patients and the current cardiac transplant waiting list. Present at the meeting were heart failure cardiologists, transplant/VAD surgeons, anaesthesiologists, mid-level and allied health providers. We adjourned to the operating room where a 23 y/o woman with Shone's syndrome who had undergone two previous operations on her mitral valve as a child complicated by endocarditis was undergoing closure of a recurrent para-valvular leak by inserting a vascular plug in the left atrium under direct vision, augmented with a prosthetic patch, by an interventional and surgical team. This treatment plan was formulated in our multidisciplinary adult congenital team meeting and clinic a few weeks previously. Meanwhile, in the hybrid operating room, an 83 y/o with aortic valve stenosis was undergoing a transapical transcatheter aortic valve implantation by a team led by a cardiac surgeon and interventional cardiologist. This patient …Heart (British Cardiac Society) 12/2014; 101(5). DOI:10.1136/heartjnl-2014-306132 · 6.02 Impact Factor
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2014; 10(5):539-41. DOI:10.4244/EIJV10I5A95 · 3.76 Impact Factor
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