Tag Archives: TAVI

The evidence supporting early discharge after TAVI Patients discharged early from hospital generally have a reduced risk of the physical and functional consequences associated with immobilisation and longer hospital stay, including hospital-acquired infections, functional dependency and cognitive decline.13,14 Elderly and frail patients are at risk of hospital-associated complications and are most likely to benefit from a shorter hospital stay.7,14 In the context of TAVI, the feasibility and safety of early discharge are well established.6–10,15 As early as 2015, early discharge was shown to be feasible and safe in approximately 80% of pat

Coronary intervention – Trials As the first ever blinded, sham-controlled, percutaneous coronary intervention (PCI) trial, demonstrating a non-statistically significant increase in exercise time at six weeks from PCI over optimal medical therapy (OMT), to say the publication of ORBITA (Percutaneous Coronary Intervention in Stable Angina) last year caused a stir would be quite the understatement. Regardless of your interpretation of the data,1 or ensuing hyperbole,2 unanswered questions certainly remained. Presentation of the previously blinded, invasive physiology data in the opening late-breaking clinical trials session here was therefore

A pathologist’s eye view of valve disease started the day with a presentation from Professor Kim Survana (Consultant Pathologist, Sheffield Teaching Hospitals NHS Trust). Covering the range from normality, to degenerative, calcific, rheumatic, congenital and infective pathology, slides of macroscopic and microscopic specimens brought to life what cardiologists see and hear in their daily practice, or as Professor John Chambers (Consultant Cardiologist, St Thomas’s Hospital, London) coined: “the reality of shadows”. Reviewing culture negative endocarditis, Dr John Klein (Consultant Microbiologist, Guy’s and St Thomas’s NHS Foundati

TAVI for asymptomatic and intermediate risk patients Indications for transcatheter aortic valve implantation (TAVI) are a critical aspect of determining the future of the therapy and this became a recurrent theme of the meeting. Current guidelines do not support the use of TAVI for those with asymptomatic aortic stenosis, as argued by Dr Bernard Prendergast (John Radcliffe Hospital, Oxford). There are some scenarios, however, where TAVI for asymptomatic aortic stenosis is appropriate, such as an immobile patient in whom symptoms have not appeared, or a frail patient with rapid progression of the condition. To date, there have been three prope

Detailed preoperative work-up and careful patient selection with input from multi-disciplinary ‘heart teams’ (cardiac surgeons, interventional cardiologists, anaesthetists, nursing staff) are integral to good practice and to minimising the risk of what remains a complex and often challenging procedure. Serious complications (e.g. severe aortic regurgitation, major bleeding, device embolisation, coronary occlusion, and aortic dissection) are uncommon (<5%), but may precipitate sudden haemodynamic collapse necessitating cardiopulmonary bypass (CPB) or other mechanical support. Current guidelines, therefore, mandate ‘full haemodynamic c

New drugs for diabetes A new DPP-4i for the management of type 2 diabetes, alogliptin (Vipidia®) has been launched by Takeda in the UK following data from EXAMINE, an outcome trial conducted in high risk acute coronary syndrome patients (see Br J Cardiol 2013;4:131) where the drug significantly reduced glucose levels and also demonstrated cardiovascular safety. Alogliptin and the fixed-dose combination product alogliptin and metformin (Vipdomet®) are now available in the UK. Alogliptin is licensed for the treatment of type 2 diabetes mellitus in adults aged 18 years and older to improve glycaemic control in combination with other glucose-lo

Caffeine intake may reduce risk of type 2 diabetes Coffee and caffeine intake may significantly reduce the incidence of type 2 diabetes, according to a new meta-analysis published in the European Journal of Clinical Nutrition.  Pertinent studies were identified by a search of PubMed and EMBASE. The fixed- or random-effect pooled measure was selected based on between-study heterogeneity. Dose–response relationship was assessed. Commenting on the implications of this study (doi: 10.1007/s00394-013-0603-x), London general practitioner Dr Sarah Jarvis said: “There is growing evidence to suggest that moderate coffee consumption, that’s four

Writing in the Journal of the American College of Cardiology (published online 15th May 2013, doi: 10.1016/j.jacc.2013.03.074), the authors point out that the number of potential TAVI candidates in the 11 countries surveyed was 158 371, meaning that TAVI remains “greatly underutilised”, with a penetration rate of 17.9%. Use of the procedure appears to be greatly influenced by how much each country spends on healthcare. Countries, such as the UK, where taxation is the principle source of healthcare funding, have a lower TAVI usage. Almost half of all implants were performed in Germany (45.9%), with Italy (14.9%) and France (12.9%) the next

WOEST: aspirin not required for stent patients on oral anticoagulants  A strategy of using clopidogrel as a single antiplatelet drug for patients receiving a drug-eluting stent who are also taking an oral anticoagulant appears safe and can reduce bleeding, the results of the WOEST study suggest. How to treat patients on anticoagulation when they receive a stent is fraught with difficulty as giving the normal dual antiplatelet therapy with aspirin and clopidogrel means they will be taking three anti-clotting agents which could increase bleeding complications to a dangerous level. But no randomised clinical trials have ever investigated whethe

UK cholesterol awareness low Millions of people in the UK hold incorrect beliefs about the risks of cardiovascular disease (CVD), according to HEART UK research. The research, which tested 1,177 people on their knowledge and concerns about high cholesterol, revealed that more than 40% of respondents wrongly thought that raised cholesterol resulted from drinking too much, while almost 60% did not know that the condition can be inherited. Almost half the population have never had a cholesterol check and only 2% of those surveyed named high cholesterol as their biggest health concern. The top health worry for people was cancer, even though CVD i