Aortic Valve Reinterventions After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis

Brown, David W.; Dipilato, Amy E.; Chong, Erin C.; Lock, James E.; McElhinney, Doff B.

doi:10.1016/j.jacc.2010.06.040

Cited by 133 publications

(95 citation statements)

References 17 publications

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“…[8][9][10] First and perhaps most importantly, our inclusion and exclusion criteria were vigorous with priority given for safety of procedure and only patients with a suitable anatomy and meeting the criteria were included for the attempted intervention. Second, this is a small-scale study involving only 1 medical centre.…”

Section: Discussionmentioning

confidence: 99%

Peri-procedural outcome of transcatheter interventions for congenital heart diseases in children in a tertiary level hospital in South Tamil Nadu, India

Masaraddi

Sukulal

et al. 2018

Int J Contemp Pediatr

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Background: Transcatheter based therapies in congenital heart defects have gained popularity, as the morbidity associated with the correction of these defects has been dramatically reduced. Complication rates in this group of children are low and our centre is striving to achieve the same outcome as other major centres. Objective of this study sought to determine the institutional complication rates in a group of children who underwent transcatheter interventions for their congenital heart diseaseMethods: This prospective observational study enrolled 125 patients who underwent elective transcatheter cardiac interventions for congenital heart defects between February 2014 and January 2018. Major and minor complications were predefined.Results: The age of these children ranged from 9 months to 18 years (mean age 9.22 years). The success rate was 99.2% (124/125). Few children (16%) had minor procedure related complications. Only 1 child had a major complication.Conclusions: Transcatheter cardiac interventions in children are highly successful. Meticulous planning and proper case selection are the major contributors for the success of any centre.

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Section: Discussionmentioning

confidence: 99%

Peri-procedural outcome of transcatheter interventions for congenital heart diseases in children in a tertiary level hospital in South Tamil Nadu, India

Masaraddi

Sukulal

et al. 2018

Int J Contemp Pediatr

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“…7,39,40 Areas under the curve (AUCs) were compared using the method proposed by DeLong et al 41 Results were considered statistically significant at P # .05. Statistical calculations were made using Stata version 12.1 (StataCorp LP, College Station, TX).…”

Section: Discussionmentioning

confidence: 99%

“…For example, at our institution, balloon valvuloplasty in patients with cath gradients $35 mm Hg has been shown to be beneficial. 39,40 In clinical practice, it is likely preferable to favor high sensitivity for identifying patients meeting this threshold over high specificity to avoid missing patients who would benefit from aortic valve relief. With these considerations, for a sensitivity of 90%, correcting the peak Doppler gradient for PR increased the specificity for a cath gradient $35 mm Hg by nearly 10%.…”

Section: Figurementioning

confidence: 99%

Correction of Doppler Gradients for Pressure Recovery Improves Agreement with Subsequent Catheterization Gradients in Congenital Aortic Stenosis

Schlingmann

Colan

Powell

2015

Journal of the American Society of Echocardiography

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“…Improved acute outcomes attributable to standardization are predicted to lead to fewer repeat interventions to address late valve dysfunction, but this will require validation over time [44,45].…”

Section: Standardized Clinical and Management Pathwaysmentioning

confidence: 99%

Reducing Cost Through Standardization

Friedman

Fulton

2016

Curr Treat Options Peds

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Opinion statementThe drive for standardization of care within pediatrics based on medical evidence is gaining momentum among hospitals and providers. Initiated by care guidelines with origins in specialty societies, adoption of pathways is now being implemented in many settings. The keys to success of these algorithms in narrowing practice variation and their potential contribution to reducing utilization of unnecessary resources are not uniformly addressed in advance. Clinical guidelines are often not updated frequently to incorporate new evidence from the literature. Education of providers about the goals and process of pathways in advance may not be sufficient depending on the commitment of the clinical champions of the algorithms. Anticipatory modeling to identify potential barriers in the workflow that interfere with proper implementation of pathways is beneficial with the opportunity to refine the algorithm where appropriate. In order to confirm cost reduction, economic data points need to be defined in advance for comparisons between preimplementation and post-implementation periods. It is possible that improved outcomes from narrowed practice variation may not always lead to cost reduction which should be reconciled by analysis of the data. Our experience with these limitations motivated our Department of Cardiology to seek a different approach to care pathways, standardized clinical and management pathways (SCAMPs) which engender algorithm design informed by existing evidence and experience of clinicians coupled with targeted questions that can be addressed by active data collection. Providers are free to depart from recommendations in the algorithm but must explain their reasons, an option that promotes participation. Data analysis combined with new medical evidence leads to iterative changes, greater standardization, and reduction of cost.

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Aortic Valve Reinterventions After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis

Abstract: although transcatheter aortic valvuloplasty is effective for relief of congenital AS, there are steady long-term hazards for surgical aortic valve reintervention and replacement that are independent of age at initial intervention or AS severity.

Cited by 133 publications

References 17 publications

Peri-procedural outcome of transcatheter interventions for congenital heart diseases in children in a tertiary level hospital in South Tamil Nadu, India

Peri-procedural outcome of transcatheter interventions for congenital heart diseases in children in a tertiary level hospital in South Tamil Nadu, India

Correction of Doppler Gradients for Pressure Recovery Improves Agreement with Subsequent Catheterization Gradients in Congenital Aortic Stenosis

Reducing Cost Through Standardization

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