2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

European Heart Journal, Journal Year: 2022, Volume and Issue: 43(39), P. 3826 - 3924

Published: Aug. 26, 2022

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Language: Английский

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Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. surgical aortic valve replacement

European Heart Journal, Journal Year: 2021, Volume and Issue: 42(30), P. 2912 - 2919

Published: June 4, 2021

Abstract Aims The aims of the study were to compare clinical outcomes and valve durability after 8 years follow-up in patients with symptomatic severe aortic stenosis at low surgical risk treated either transcatheter implantation (TAVI) or replacement (SAVR). Methods results In NOTION trial, randomized TAVI SAVR. Clinical status, echocardiography, structural deterioration, failure assessed using standardized definitions. total, 280 (n = 145) SAVR 135). Baseline characteristics similar, including mean age 79.1 ± 4.8 a STS score 3.0 1.7%. At 8-year follow-up, estimated composite outcome all-cause mortality, stroke, myocardial infarction was 54.5% 54.8% (P 0.94). risks for mortality (51.8% vs. 52.6%; P 0.90), stroke (8.3% 9.1%; (6.2% 3.8%; 0.33) similar deterioration lower than (13.9% 28.3%; 0.0017), whereas bioprosthetic (8.7% 10.5%; 0.61). Conclusions SAVR, there no significant differences infarction, as well follow-up. trial registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT01057173.

Language: Английский

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TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery

European Heart Journal, Journal Year: 2021, Volume and Issue: 43(7), P. 654 - 662

Published: Sept. 8, 2021

Isolated tricuspid valve surgery (ITVS) is considered to be a high-risk procedure, but in-hospital mortality markedly variable. This study sought develop dedicated risk score model predict the outcome of patients after ITVS for severe regurgitation (TR).

Language: Английский

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Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation

New England Journal of Medicine, Journal Year: 2021, Volume and Issue: 386(4), P. 327 - 339

Published: Nov. 13, 2021

Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base insufficient to inform a decision about whether perform tricuspid-valve repair during mitral-valve surgery who have moderate tricuspid or less-than-moderate annular dilatation. We randomly assigned 401 were undergoing for receive procedure without annuloplasty (TA). The primary 2-year end point was composite of reoperation regurgitation, progression by two grades from baseline presence death. Patients underwent plus TA had fewer primary-end-point events than those alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 0.86; P = 0.02). Two-year mortality 3.2% surgery-plus-TA group and 4.5% surgery-alone 0.69; CI, 0.25 1.88). prevalence lower (0.6% 6.1%; relative 0.09; 0.01 0.69). frequencies major adverse cardiac cerebrovascular events, functional status, quality life similar groups at 2 years, although incidence permanent pacemaker implantation higher (14.1% 2.5%; rate ratio, 5.75; 2.27 14.60). Among surgery, also received event reduction that driven less frequent resulted more implantation. Whether reduced results long-term clinical benefit can be determined only longer follow-up. (Funded National Heart, Lung, Blood Institute German Center Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.).

Language: Английский

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Cardiovascular Manifestations From Therapeutic Radiation

JACC CardioOncology, Journal Year: 2021, Volume and Issue: 3(3), P. 360 - 380

Published: Sept. 1, 2021

Radiation therapy is a cornerstone of cancer therapy, with >50% patients undergoing therapeutic radiation. As result widespread use and improved survival, there increasing focus on the potential long-term effects ionizing radiation, especially cardiovascular toxicity. can lead to atherosclerosis vasculature as well valvular, myocardial, pericardial dysfunction. We present consensus statement from International Cardio-Oncology Society based general principles radiotherapy delivery risk assessment mitigation in this population. Anatomical-based recommendations for management follow-up are provided, priority given early detection atherosclerotic vascular disease imaging help guide preventive therapy. Unique considerations radiation-induced also discussed. Recommendations most current literature represent unanimous by multidisciplinary expert panel.

Language: Английский

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Apixaban vs. standard of care after transcatheter aortic valve implantation: the ATLANTIS trial

European Heart Journal, Journal Year: 2022, Volume and Issue: 43(29), P. 2783 - 2797

Published: April 29, 2022

Abstract Aims The respective roles of oral anticoagulation or antiplatelet therapy following transcatheter aortic valve implantation (TAVI) remain debated. ATLANTIS is an international, randomized, open-label, superiority trial comparing apixaban to the standard care. Methods and results After successful TAVI, 1500 patients were randomized (1:1) receive 5 mg (2.5 if impaired renal function concomitant therapy) (n = 749) twice daily, care 751). Randomization was stratified by need for chronic therapy. Standard-of-care received a vitamin K antagonist (VKA) (Stratum 1) 2) there indication not, respectively. primary endpoint composite death, myocardial infarction, stroke transient ischaemic attack, systemic embolism, intracardiac bioprosthesis thrombosis, deep vein thrombosis pulmonary life-threatening, disabling, major bleeding over 1-year follow-up. safety major, life-threatening bleeding. outcome occurred in 138 (18.4%) 151 (20.1%) receiving care, respectively [hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.73–1.16] no evidence interaction between treatment stratum (Pinteraction 0.57). similar both groups (HR 1.02; CI 0.72–1.44). In Stratum 1 451), exploratory analysis showed difference all endpoints VKA. 2 1049), did not differ, but obstructive reduced with vs. 0.19; 0.08–0.46), while signal higher non-cardiovascular mortality observed apixaban. Conclusion superior irrespective anticoagulation.

Language: Английский

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The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

European Heart Journal, Journal Year: 2021, Volume and Issue: 42(13), P. 1254 - 1269

Published: Feb. 21, 2021

Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. contributes to progression symptoms and signs HF confers worse prognosis. The management patients SMR is complex requires timely referral a multidisciplinary Heart Team. Optimization pharmacological device therapy according guideline recommendations crucial. Further careful clinical imaging assessment, addressing anatomical functional features ventricle, overall status, relevant comorbidities. Evidence concerning surgical correction sparse it doubtful whether this approach improves Transcatheter repair has emerged as promising alternative, but conflicting results current randomized trials require interpretation. This collaborative position statement, developed by four key associations European Society Cardiology-the Failure Association (HFA), Percutaneous Cardiovascular Interventions (EAPCI), Imaging (EACVI), Rhythm (EHRA)-presents an updated practical evaluation based upon Team approach.

Language: Английский

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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 Update on Outcomes and Research

The Annals of Thoracic Surgery, Journal Year: 2023, Volume and Issue: 115(3), P. 566 - 574

Published: Jan. 6, 2023

Language: Английский

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Economic Issues in Heart Failure in the United States

Journal of Cardiac Failure, Journal Year: 2022, Volume and Issue: 28(3), P. 453 - 466

Published: Jan. 24, 2022

Language: Английский

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Sex Differences and Similarities in Valvular Heart Disease

Circulation Research, Journal Year: 2022, Volume and Issue: 130(4), P. 455 - 473

Published: Feb. 17, 2022

As populations age worldwide, the burden of valvular heart disease has grown exponentially, and so proportion affected women. Although rheumatic valve is declining in high-income countries, degenerative age-related causes are rising. Calcific aortic stenosis mitral regurgitation affect a significant elderly women, particularly those with comorbidities. Women have been underrepresented many landmark studies which form basis for guideline recommendations. consequence, surgical referrals women often delayed, worse postoperative outcomes compared men. described this review, more recent effort to include research clinical trials increased our knowledge about sex-based differences epidemiology, pathophysiology, diagnostic criteria, treatment options, outcomes, prognosis.

Language: Английский

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