TAVI in 2015: who, where and how?

Ruparelia, Neil; Prendergast, Bernard

doi:10.1136/heartjnl-2014-307008

Cited by 24 publications

(16 citation statements)

References 89 publications

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“…From a patient safety perspective, and in our clinical experience, fostering a truly multidisciplinary approach by having a clinical perfusionist, cardiac surgeon and cardiothoracic anaesthetist present for all TAVI procedures is invaluable in the event of an emergency, particularly one requiring cardiopulmonary bypass. This sentiment is echoed in the literature, with the concept of the multidisciplinary ‘heart team’ for patient assessment and treatment gaining increasing prominence in many centres in the UK .…”

Section: Discussionmentioning

confidence: 99%

General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study

et al. 2016

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SummaryReported data suggest that 99% of transfemoral, transcatheter aortic valve implantations in the UK are performed under general anaesthesia. This before-and-after study is the first UK comparison of conscious sedation vs. general anaesthesia for this procedure. Patients who underwent general anaesthesia received tracheal intubation, positive pressure ventilation, radial arterial and central venous access and urinary catheterisation. Anaesthesia was maintained with propofol or sevoflurane. Patients who received conscious sedation had a fascia iliaca and ilioinguinal nerve block and low-dose remifentanil infusion, without invasive monitoring or urinary catheterisation. Recruitment took place between August 2012 and July 2015, with a 6-month crossover period between November 2013 and June 2014. A total of 88 patients were analysed, evenly divided between the two groups. Patients receiving conscious sedation had a shorter anaesthetic time (mean (SD) 121 (28) min vs. 145 (41) min; p < 0.001) and recovery room time (110 (50) min vs. 155 (48) min; p = 0.001), lower requirement for inotropes (4.6% vs 81.8%; OR (95% CI) 0.1 (0.002-0.050); p < 0.001) and a lower incidence of malignant dysrhythmia (0% vs 11.4%; p = 0.020). Conscious sedation appears a feasible alternative to general anaesthesia for this procedure and is associated with a reduced requirement for inotropic support and improved efficiency.

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Section: Discussionmentioning

confidence: 99%

General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study

et al. 2016

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“…Cardiac resynchronisation therapy is used widely for patients with advanced heart failure, and implantable (intracardiac) cardioverter defibrillators are commonly inserted for prevention of ventricular arrhythmias 45 . Similarly, in the last 15 years, transcatheter aortic valve implantation (TAVI) has gone from concept to clinical reality, and over 100,000 valves have now been implanted worldwide 46 . Cardiac device infection (CDI) currently accounts for roughly 10% of IE, and as use of cardiac devices and valve prostheses increases further, cardiologists should expect increasing rates of IE 3 .…”

Section: Management Of Infective Endocarditismentioning

confidence: 99%

Current controversies in infective endocarditis

Cahill

Prendergast

2015

F1000Res

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Infective endocarditis is a life-threatening disease caused by a focus of infection within the heart. For clinicians and scientists, it has been a moving target that has an evolving microbiology and a changing patient demographic. In the absence of an extensive evidence base to guide clinical practice, controversies abound. Here, we review three main areas of uncertainty: first, in prevention of infective endocarditis, including the role of antibiotic prophylaxis and strategies to reduce health care-associated bacteraemia; second, in diagnosis, specifically the use of multimodality imaging; third, we discuss the optimal timing of surgical intervention and the challenges posed by increasing rates of cardiac device infection.

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“…[7][8][9], there is an ongoing discussion on whether this is appropriate and sufficient in allocating patients to TAVI instead of (surgical) AVR [10][11][12][13]. Patients would ideally be selected for TAVI or SAVR after discussion by a multidisciplinary heart team [14,15]. Measures of frailty that are associated with adverse outcomes, but not incorporated in current risk prediction models, can then also be taken into account.…”

Section: Introductionmentioning

confidence: 99%

Patient selection for cardiac surgery: Time to consider subgroups within risk categories?

Giessen

Wit

Smit

et al. 2016

International Journal of Cardiology

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We illustrated a feasible method to identify homogeneous subgroups of individuals typically comprising risk categories. This allows a single treatment strategy--optimal only on average, across all individuals in a risk category--to be replaced by subgroup-specific treatment strategies, bringing us another step closer to individualized care. Discussions on allocation of cardiac surgery patients to different interventions may benefit from focusing on such specific subgroups.

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TAVI in 2015: who, where and how?

Cited by 24 publications

References 89 publications

General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study

General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study

Current controversies in infective endocarditis

Patient selection for cardiac surgery: Time to consider subgroups within risk categories?

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