The Journal of invasive cardiology
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Multicenter Study Comparative Study
Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology Guidelines for the Management of Patients With Valvular Heart Disease.
The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) have developed guidelines to assist clinicians in making evidence-based decisions. This study compares the ACC/AHA and ESC guidelines for the management of patients with valvular heart disease (VHD). ⋯ The ACC/AHA VHD guidelines contain significantly more recommendations. The distribution of COR was similar, but the ACC/AHA guidelines included more LOE B recommendations and fewer LOE C recommendations, suggesting that the ACC/AHA guidelines place greater emphasis on published data than expert opinion. Overall, the ACC/AHA and ESC guidelines provide similar recommendations, suggesting consistency in practice; however, the relative paucity of LOE A recommendations highlights the need for additional research.
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Review Meta Analysis
Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement in Low-Intermediate Surgical Risk Patients: A Systematic Review and Meta-Analysis.
Transcatheter aortic valve replacement (TAVR) is a viable alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (SAS) who are at high risk for surgery. We sought to evaluate the outcomes of TAVR vs SAVR in low-intermediate risk patients with SAS. ⋯ TAVR appears to be a suitable alternative for patients with SAS who are at low-intermediate risk for SAVR.
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The Society of Thoracic Surgery (STS) risk score serves as an important determinant of eligibility for transcatheter aortic valve replacement (TAVR). The STS score's validity for predicting TAVR mortality, however, is incompletely understood. This study compares the STS score's discriminatory power for TAVR mortality as compared with surgical aortic valve replacement (SAVR) mortality. ⋯ The STS score possesses predictive value for 30-day mortality in both SAVR and TAVR. Although not designed for TAVR, the STS score may provide some insight into TAVR mortality, and therefore serves as an appropriate model for efforts to develop a TAVR-specific risk prediction instrument.
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Comparative Study
Comparative Matched Outcome of Evolut-R vs CoreValve Transcatheter Aortic Valve Implantation.
The Evolut-R (Medtronic, Inc) is a transcatheter aortic valve implantation (TAVI) system that was built on the well-established foundation of Medtronic's CoreValve device platform. Although already in extensive clinical utilization, it is unknown if the Evolut-R improves TAVI outcomes. Herein, we compared TAVI outcomes of the Evolut-R and CoreValve devices. ⋯ This study indicates that the efficacy and safety of the self-expandable second-generation Evolut-R transcatheter valve is at least comparable with the first-generation CoreValve. The observed improved performance in correct positioning of a single valve and the numerically lower chance to suffer a combined TAVI endpoint needs further investigation.
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A 75-year-old man presented with infective endocarditis. Transesophageal echocardiogram (TEE) revealed mild-moderate mitral regurgitation (MR). After 4 weeks of antibiotics, he presented with New York Heart Association class III dyspnea. ⋯ After consultation with Infectious Diseases, it was determined the infection risk was low and transcatheter mitral valve repair (TMVR) was offered. Deployment of two MitraClip devices (Abbott Vascular) resulted in symptom relief. This case demonstrates a potential role of TMVR in treating acute severe MR due to endocarditis.