No abstract

Objective Whether patients with severe aortic stenosis (AS) and significant functional mitral regurgitation (MR) should undergo isolated aortic (aortic valve replacement [AVR]) or double aortic‐mitral valve procedure (DVP) remains controversial. We sought to determine outcomes of such patients undergoing surgical (surgical aortic valve replacement [SAVR]) and transcatheter AVR (TAVR) or DVP, identify echocardiographic parameters predictive of significant residual MR after isolated AVR, and determine its impact on long‐term survival. Methods Data prospectively collected from 736 consecutive patients with severe AS and significant MR undergoing AVR or DVP were retrospectively analyzed. Exclusion of organic MR, other valve diseases and concomitant CABG yielded a final population of 74 patients with significant functional MR (32 TAVR, 23 SAVR, 19 DVP). Demographics, postoperative complications and age‐adjusted survival were compared. Echocardiographic predictors of significant residual MR and its impact on survival were analyzed for patients undergoing isolated AVR. Results In the isolated AVR group, MR improvement occurred in 60% of patients and was associated with a significant increase in survival compared to persistence of significant MR (p = .03). Patients with improved MR had significantly greater preoperative left ventricular dilatation (LVEDD: 49 vs. 43 mm, p = .001; LVESD: 35 vs. 29 mm, p = .03; LVEDV: 101 vs. 71 ml, p = .0003; LVESV: 57 vs. 33 ml, p = .002). There was no significant difference in perioperative mortality (5.3 vs. 4.4 vs. 9.4%, p = .85) or age‐adjusted long‐term survival between isolated AVR and DVP groups (76.3 vs. 84.2% survival at 2‐year follow‐up, p = .26), or between SAVR, TAVR and DVP groups (78.2 vs. 75.0 vs. 84.2% survival at 2‐year follow‐up, p = .13). Conclusions After isolated AVR, MR improvement occurs in 60% of patients. It is predicted by greater ventricular dimensions and associated with significantly better long‐term survival. Whether a staged approach with transcatheter correction of MR should be considered in patients with significant residual MR following AVR remains undetermined.

No abstract

No abstract

BACKGROUND: At least 40% of adults have 1 lifetime faint and 20% of adults faint recurrently. Despite its alarm, the incidence of associated injuries is unknown. Purpose: To determine the incidence, severity, and predictors of injuries due to syncope in patients (pts) in 3 syncope clinical trials. METHODS AND RESULTS: POST studies are multicenter randomized syncope treatment trials. POST 2 and 4 studied fludrocortisone and midodrine for vasovagal syncope, and POST 3 studied management strategies for bifascicular block and syncope. Injuries were recorded during the year after enrollment. Injury was categorized as minor (bruising, scrapes), moderate (lacerations), and severe (fracture, burns, joint pain). Results: 183/459 pts had 1 faint, for a total of 645 faints. The median ages were 34 y with a median 3 faints in the prior yr. 59/ 194 pts (30%) had at least 1 injury related to syncope, and 103/698 faints (15%) resulted in injury. Of 459 pts, 48 (10%), 7 (2%), and 4 (1%) had minor, moderate and severe injuries, respectively. Of 59 injured pts, 81%, 12%, and 7% had minor, moderate and severe injuries, respectively. Of 103 injuries, 83 (81%), 16 (16%), and 4 (4%) were minor, moderate, and severe, respectively. The sex of the pt did not predict injury-free survival (male vs female, 71.2% vs 67.7% p¼0.43), nor did age above and below median age (old vs young, 70.8% vs 67% p¼0.92). None of age, sex and prior year syncope frequency predicted injury severity (age, minor vs rest p¼0.48; sex, minor vs rest, p¼0.54; frequency, minor vs rest p¼0.52). Patients with 3 or more syncope in prior year were more likely to get injured in the follow up period, cumulative incidence 35% vs 26%, p¼0.02 Wilcoxon. Presence of prodromes did not prevent injuries. In POST 3 and 4, injuries occurred in 16/67 pts (24%) with a history of prodromes in prior year and 14/ 30 pts (47%) without a history of prodromes in prior year, p¼0.12 Logrank (Figure 1). Also, In POST 3 and 4, injuries occurred in 13/31 pts (42%) without prodromes and 17/66 pts (26%) with prodromes, p¼0.31, Logrank (Figure 2). CONCLUSION: Injuries are frequent in syncope patients, occurring in 15% of faints. Most injuries are bruises, and musculoskeletal injuries are uncommon. Patients with frequent syncope are more likely to be injured, while age, sex and presence of prodromes did not predict injury.