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2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Journal of the American College of Cardiology (Impact Factor: 15.34). 10/2008; 52(13):e1-142. DOI: 10.1016/j.jacc.2008.05.007
Source: PubMed
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    • "Aortic stenosis disease (AS) is a common native valve disease found in up to 5% of the elderly population.1 Surgical aortic valve replacement (AVR) is the standard treatment for patients with symptomatic severe AS.2 However, despite the accepted results of conventional surgery, surgical risk is markedly increased in elderly patients with comorbidities. "
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    ABSTRACT: Purpose We sought to evaluate the clinical usefulness of decision making by a multidisciplinary heart team for identifying potential candidates for transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis. Materials and Methods The multidisciplinary team consisted of two interventional cardiologists, two cardiovascular surgeons, one cardiac imaging specialist, and two cardiac anesthesiologists. Results Out of 60 patients who were screened as potential TAVI candidates, 31 patients were initially recommended as appropriate for TAVI, and 20 of these 31 eventually underwent TAVI. Twenty-two patients underwent surgical aortic valve replacement (AVR), and 17 patients received only medical treatment. Patients who underwent TAVI and medical therapy were older than those who underwent surgical AVR (p<0.001). The logistic Euroscore was significantly highest in the TAVI group and lowest in the surgical AVR group (p=0.012). Most patients in the TAVI group (90%) and the surgical AVR group (91%) had severe cardiac symptoms, but only 47% in the medical therapy group had severe symptoms. The cumulative percentages of survival without re-hospitalization or all-cause death at 6 months for the surgical AVR, TAVI, and medical therapy groups were 84%, 75%, and 28%, respectively (p=0.007, by log-rank). Conclusion TAVI was recommended in half of the potential candidates following a multidisciplinary team approach and was eventually performed in one-third of these patients. One-third of the patients who were initially considered potential candidates received surgical AVR with favorable clinical outcomes.
    Yonsei Medical Journal 09/2014; 55(5):1246-52. DOI:10.3349/ymj.2014.55.5.1246 · 1.26 Impact Factor
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    • "The ejection fraction, stroke volume, and the cardiac output for both ventricles were derived. Severity of aortic stenosis was estimated using 3 methods: -The Calc-PG: inverse Hakki's formula [15] [21], which is a simplification of Gorlin's [14] formula; DP = (cardiac output/ aortic valve area) [2]. -The aortic valve planimetry. "
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    ABSTRACT: Aim Cardiovascular magnetic resonance (CMR) has been increasingly used as an alternative method to evaluate the severity of aortic stenosis. The aim of our study was to evaluate whether the indirect measurement of the aortic gradient (Calc-PG), derived from Gorlin's formula, is a reproducible parameter for gradient assessment. Then, we evaluated if this parameter is correlated with left ventricular hypertrophy, considered as a marker of severity of aortic stenosis, better than phase-contrast sequences-derived pressure gradient (PC-PG) and aortic valve area. Methods Forty-one patients with isolated aortic stenosis underwent CMR. Calc-PG was obtained from the formula (cardiac output/aortic valve area)2, and it was compared to PC-PG. Results We found that the Calc-PG has higher correlation with left ventricle mass than PC-PG (r2 0.44, p < 0.001 vs. r2 0.26, p < 0.01), also after multivariate analysis adjusting for age, gender and hypertension (p < 0.001). Furthermore, Calc-PG was more reproducible than PC-PG. The receiver operating characteristic comparison curve analysis showed that Calc-PG has a significantly higher ability to describe the presence of left ventricular hypertrophy than PC-PG (area under the curve 0.85, 95% CI 0.70–0.94, p < 0.0001 vs. 0.74, 95% CI 0.58–0.87, p = 0.03). Conclusions We propose that transaortic gradient indirectly calculated by using the simplified Gorlin's equation could be an alternative method to assess the severity of aortic stenosis.
    Journal of Cardiology 08/2014; 65(5). DOI:10.1016/j.jjcc.2014.07.015 · 2.57 Impact Factor
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    • "The recommendation for the management of OAC in minor dental procedures such as simple dental extraction has been proposed on the basis of clinical data; however, a consensus on which patients require invasive dental procedures is lacking.4,5,6 In clinical practice, conventional care with a short-acting anticoagulant as "bridge therapy" is commonly used to decrease the risk of thromboembolism during the cessation of OAC therapy.7,8,9 Intravenous unfractionated heparin (UFH) is the conventional medication used for bridging; however, it can be expensive and time-consuming, because periprocedural hospitalization for administering and laboratory monitoring is imperative. "
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    ABSTRACT: Purpose Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain. Materials and Methods This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures. Results This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures. Conclusion Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.
    Yonsei Medical Journal 07/2014; 55(4):937-43. DOI:10.3349/ymj.2014.55.4.937 · 1.26 Impact Factor
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