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Journal and News Scan
In this paper the authors use data from cohort A of the PARTNER trial to evaluate the effect of preoperative moderate to severe mitral regurgitation on survival at two years in patients treated with surgical aortic valve replacement (SAVR) and TAVI. Mitral regurgitation improved significantly in both groups at 30 days. Preoperative mitral regurgitation had a negative effect on survival in the SAVR group but not in the TAVI group. The authors conclude that TAVI may be a reasonable treatment option in a selected group of patients with aortic stenosis and mitral regurgitation.
Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. The present systematic review was conducted to analyze the cost–effectiveness of this novel technique within reimbursed healthcare systems. Depending on the ICER threshold selected, TAVI is potentially justified on both medical and economic grounds compared with medical therapy for patients deemed to be surgically inoperable. However, in the high–risk surgical patient cohort, the evidence is currently insufficient to economically justify the use of TAVI in preference to AVR.
- Two reviewers used 7 electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies of TAVI versus AVR or medical therapy.
- The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness.
- The eligible studies for the present systematic review included those in which the cost-effectiveness data were measured or projected for TAVI and either medical therapy or AVR.
- All forms of TAVI were included, and all retrieved publications were limited to the English language.
- Eight studies were included for quantitative assessment.
- The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged from US$26,302 to US$61,889 per quality-adjusted life year gained.
- The probability of TAVI being cost-effective compared with medical therapy ranged from 0.03 to 1.00.
- The ICER values for TAVI compared with AVR for high-risk surgical candidates ranged from US$32,000 to US$975,697 per quality-adjusted life year gained.
- The probability of TAVI being cost-effective in this cohort ranged from 0.116 to 0.709.
The purpose of this meta–analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. The authors conclude the non–inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.
Six electronic databases were searched for original published studies from January 2000 to August 2013.
Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures.
All data were extracted and tabulated from the relevant articles’ texts, tables, and figures and checked by another reviewer.
Overall 435 publications were identified.
After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction.
There was one randomized controlled trial (RCT) and three prospective observational studies.
At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P<0.0001).
The number of patients with post-procedure residual MR severity >2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001).
30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66).
An unnamed man who was "nearing the end of his life," according to doctors, became the first person to receive an artificial heart on Wednesday at the Georges Pompidou European Hospital in Paris
Unlike previous heart replacement devices, the Carmat heart is intended to last for as long as five years. It is fully artificial, yet closer to a human heart than any other heart device developed so far. "If your loved one came through the door [and you had a Carmat artificial heart], it would start to beat faster, just like a real one," Alain Carpentier, who developed the heart and led last week's surgery, told reporters in a press conference,
Bicuspid aortic valve (BAV) has been considered as a relative contraindication for transcatheter aortic valve implantation (TAVI) in aortic valve stenosis. In this retrospective study of the German TAVI registry, the authors have compared outcomes in patients with bicuspid and tricuspid aortic valves (TAV). Out of the 1424 patients included in the registry, 38 had bicuspid aortic valves. After TAVI, the incidence of significant aortic regurgitation (≥II) was significantly higher in patients with BAV (25 vs 15%). Interestingly, the need for pacemaker implantation was higher in patients with TAV (35 vs 17%). There was no difference in 30 day mortality and BAV was not found to be associated with 1-year mortality in the univariate and Cox regression analysis. Although the findings are interesting, they should be interpreted with caution because of the nature of the study.
This prospective study evaluated changes in diaphragm thickness during weaning trials in ventilated patients as a predictor of successful weaning. An increase in thickness of more than 30% between end-expiration and end-inspiration had a positive predictive value of 91% and an area under the ROC curve of 0.79.
In this study the authors evaluate the results of intramyocardial injection of human resident cardiac stem cells and blood derived circulatory angiogenic cells in a mouse myocardial infarction model, comparing the effect on ventricular function and myocardial repair of combined and individual administration of the cells. Better post-infarct ventricular function and myocardial repair were observed with combination therapy than when either type of cell was given alone.
Percutaneous edge to edge repair with MitraClip is typically used in situations of central mitral insufficiency (MI). In this study, the authors evaluate the applicability of this technique in non-central MI. They have carried out a retrospective analysis of their own results in a group of 79 patients. Although patients with non-central MI had higher pulmonary pressures and wider basal vena contracta, there were no significant differences in procedural success or complications. In addition, there were no significant differences in all-cause mortality, readmission for heart failure, residual MI and NYHA status at 1 and 6 months. Although the study is probably too small in size as to provide strong evidence, the results suggest that non-central MI could be amenable to treatment with percutaneous edge to edge repair techniques.
This excellent video and accompanying text provide a nice description of Swan-Ganz catheter insertion.
The issue of this single center experience was to analyze whether the concomitant cardiac surgery had a negative impact during the implantation and the follow up in patients with long term LVAD. The results are encouraging.