Viv-TAVI : Bio-Analysis

This past Friday in the cardiac catheterization lab I began my day with continuing the work that I was previously assigned to do last week where I collected the data of patient's Cardiothoracic surgery. I continued to familiarize myself with the different types of Cardiothoracic surgery procedures, however, the specific reports I was working with, they are called TAVR report (Transcatheter Aortic Valve Replacement). I later learned and was explained to, the TAVR multiple procedures and its causes, which is aortic stenosis. As for the procedures, a valve needs to be placed in the heart and each procedure delivers it a different way. The three ways the valve can be placed in the heart is through the heart's femoral artery (the transfemoral approach),

All TAVI procedures were performed in a hybrid catheterization laboratory by the team comprised of interventional cardiologist, cardiac surgeon or vascular surgeon, anesthesiologist, echocardiographer, nurses and technicians as previously described [15]. The general or local anaesthesia and sedation, without the use of cardiopulmonary bypass was applied. Procedures were performed under angiographic and echocardiographic guidance. Before the procedure, a temporary pacing lead was inserted into the right ventricle through a jugular or femoral vein. Arterial access was obtained by cannulation of the right or left common femoral artery, with postprocedural haemostatasis achieved by using vascular closure systems (StarClose or Proglide), or by direct

Promising results have shown that the Angio-seal VCD has excellent efficacy and safety after routine catheterization and intervention. However, clear indications of use and risk of complications need to be evaluated and monitored.

Aortic Stenosis is recognised as the most prevalent form of valvular heart disease in the ageing population. Increasing life expectancy has resulted in a significant increase in the number of older patients being referred for consideration of an aortic valve replacement. Although surgical aortic valve replacement (AVR), or open heart surgery, remains the best type of treatment for symptomatic severe aortic stenosis, other treatment options include: Transcatheter Aortic Valve Implantation (TAVI); balloon aortic valvuloplasty (BAV); medical therapy. Transcatheter Aortic Valve Implantation, also referred to as Transcatheter Aortic Valve Replacement, is one of the least invasive types of aortic valve replacement surgeries. TAVi is important to

“Valvular heart disease is responsible for more than 22 000 deaths each year in the United States. (Patel, Green et al 2014). Thousands of people live long and healthy lives not knowing the they have valvular disease. Due to this, majority of these deaths are from the elderly population. Those who have succumbed to this disease, apart from those who attained it due to congenital reasons, usually have another disease of the heart or vascular system such as coronary disease or hypertension. The risk factors “ include male sex, smoking, hypertension, elevated low‐density lipoprotein cholesterol (LDL), coronary atherosclerosis, congenital bicuspid valve, and advanced age ( Patel, Green et al 2014). According to the article, men are at a higher risk for valvular disease than women, however, advanced age is the most significant risk factor for attaining this disease. When patients become symptomatic, the treatments of valvular stenosis become necessary in order to increase the quantity of blood needed for systemic circulation, thus prolonging quality of life.

Thus, in the current era, It is much more common to perform interventional cardiac catheterization rather than for

After years of what sometimes seemed painstaking slow efforts to bring a less invasive approach to managing mitral valve (MV) disease, things are finally moving forward on several fronts. It 's likely a response to the eye-opening clinical success and rapid adoption of transcatheter aortic valve replacement (TAVR). The success of TAVR has reinvigorated efforts to develop less invasive approaches to the other heart valves. It has not been easy, but the transcatheter revolution marches on.

The previous articles discussed the rate of infection among patients with pacemaker implant and the risk factors associated with cardiovascular implant electric device (CIED) infection. In the study done by Voigt, Shalaby, & Saba (2010), they stated that the rate of pacemaker has increased from 0% between 1996 and 2002 to 8.9% in 2003, to 15.8% in 2005 and 14.3% in 2006 but they claimed that the cases of CIEDs infections was faster than the implantation of those devices . Furthermore, Beddour et al (2010) found that the rate of CIED infection increased over time and it was estimated by 18% from 210 of patients having pacemaker implant. This rise was observed among patients with diabetes mellitus, immunosuppression caused by renal

The first task force provided recommendations for identifying patients who may receive an LVAD. Potential candidates should have reversible causes of heart failure addressed prior to consideration (Class I, level of evidence A). Patients being considered for an LVAD must have their transplant candidacy assessed prior to implant due to heart transplants providing superior long-term outcomes (Class I, level of evidence A). Candidates should have their NYHA class and INTERMACS profile assessed prior to implant (Class I, level of evidence C). 4 The INTERMACS has demonstrated significance in predicting mortality and postoperative complications following the implantation of LVADs. 5 Assessing and managing comorbidities is another central component

Left Ventricular Assistant Devices or LVAD are the new means of delaying death from end stage cardiac failure when all other means such as medicines, and other procedures have failed. Patients who are option to have the LVAD must meet key indicators to qualify, which is discussed and determined by their physician (Cleveland Clinic 2014). While there is still much research out there being done on LVAD and the short term, as well as long term effects, certain types of machines such as the HeartMate II have been stamped with the go ahead from the FDA. (FDA 2012). While it is not certain exactly how long it will take for perfection, improvements in methods and procedures have been seen. Extended survival rates meeting the time for transplants have

Prosthesis-patient mismatch (PPM) is caused by Effective orifice area provided by prosthetic valve which is small and Incompatible in relation to the body surface area (BSA) of the patient(1,2) . Despite of normal functioning prosthetic mitral valve, due to the small and incompatible EOA of the prosthetic valve, the mean gradient in postoperative period was found to be relatively high which is equivalent to mild-moderate mitral stenosis(2-4). Regression of left atrial pressure and pulmonary artery hypertension is prevented by PPM in the mitral position (5,6) . PHT causes right ventricular dysfunction thereby increases cardiovascular morbidity and mortality. As a result, prime objective of MVR is to restore normal PAP(7-9).

This issue is not stranger to patients who underwent TAVR in whom the prevalence of coexistent moderate-to-severe MR and TR have been estimated in around 20% to 30% and 27% respectively. Until recently, although the real prognostic impact of MR among patients undergoing TAVR remains unanswered, despite multiple studies in last years that report conflicting results. Nevertheless, it is seem that significant MR is associated with an increase in mortality after TAVI when mitral valve left untreated.

Conclusion: Percutaneous coronary intervention and TAVR execution as a single procedure can occur in discerning patient population as it does not increase the risk of mortality even in the setting of severe multi-organ involvement.

A treatment plan HF includes treating HF symptoms, preserve heart function, and diseases resulted HF, which AS in Mr. B case. ACC and AHA (2014) recommendation for treating AS is as follow: patient with AS stage A or asymptomatic AS stage B and C should be treated medically with low aspirin and guideline determined medical therapy (GDMT) for hypertension. In addition, this patients need frequent monitor for HF symptoms and syncope. Mechanical correction is recommended for patients with symptomatic AS and asymptomatic AS stenosis stage C2. Mechanical correction is also recommended in those who are going to other cardiac surgery and has Stage C or D AS. AS mechanical correction can be in form surgical aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVR). TAVR is used only in the patients who has high surgical risk and life expectancy more than a year.

A second strategy for change could be a financial incentive for the patient in the form of a service discount to encourage a choice and selection of a VCD procedure. This could be made possible if there was a decrease in patient complications and length of stay savings that the hospital money that could pass on to continue the cycle of VCDs procedure selection. A second barrier is the preforming physician’s preference of whether to use a VCD verses MC at the termination of the cardiac procedure. This maybe the greatest barrier as some doctors are set in their choice and regardless of evidence based practice of a better way. In an emergent situation, the cardiac doctor that is on call for Code STEMI and his preferred methods the patient is basically stuck with, while a Non STEMI or a scheduled procedure with proper education the patient may choose the doctor that advocates the use of a VCD and fix this barrier by directly impacting the non-participating doctors financial bottom line. Because each physician has the freedom to choose which method they prefer for the patient to achieve hemostasis and maybe resistant to change the engagement of doctors that currently use VCD should be