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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Symptomatic patients with severe MR should be referred to a cardiac surgical centre for consideration of mitral valve surgery. Surgery depends on anatomy and comorbidities and is either a surgical repair or mitral valve replacement. In patients with very high perioperative risk due to comorbidities, a percutaneous MitraClip may be indicated. Guidelines provide thresholds of LV volumes and function at which surgery is recommended in asymptomatic patients with severe MR before LV dysfunction develops.
Infective Endocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Optimal therapy of infective endocarditis requires bactericidal antibiotics for a prolonged period. The exact duration and use of single-drug vs combination drug therapy varies according to the pathogen, presence of antibiotic resistance and whether the infection involves a native or prosthetic valve. Increasing antibiotic resistance complicates the treatment of S. aureus infective endocarditis. Indications for surgical valve replacement include acute complications, such as severe valve dysfunction, abscess formation, heart failure and embolization, recurrent embolic events with residual vegetation, and multidrug-resistant organism, or persistent bacteremia.
Cardiology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
Valve replacement – indications are: Symptomatic, esp. syncope or chest painValve area <0.5 cm2Peak systolic gradient > 64 mmHg
Association of red blood cell distribution width with post-operative new-onset atrial fibrillation following cardiac valve replacement surgery: a retrospective study
Published in Biomarkers, 2022
Li Xin, Chu Chenghao, Hou Shuwen, Ge Shenglin, Zhang Chengxin
This retrospective observational study was conducted at The First Affiliated Hospital of Anhui Medical University in China. We evaluated the clinical data of 609 consecutive patients who underwent cardiovascular surgery in our centre from September 2017 to June 2018. Patients were excluded because of (1) non-valvular surgery; (2) preoperative arrhythmia; (3) emergency surgery; (4) history of cardiac surgery; (5) hematological disease; and (6) unavailable medical records. Finally, 148 patients were eligible for participation in this study and inclusion in the data analysis. All of them underwent isolated valve replacement surgery, including mitral valve replacement, aortic valve replacement, and double valve (mitral and aortic valve) replacement. This study was approved by the ethics committees of our hospital and conducted following the rules of Good Clinical Practice and principles of the Declaration of Helsinki. Individual consent was waived owing to the retrospective study design.
Hypoxia-inducible factor (HIF) inhibitors: a patent survey (2016–2020)
Published in Expert Opinion on Therapeutic Patents, 2021
Hyun Seung Ban, Yoshikazu Uto, Hiroyuki Nakamura
Emory University disclosed methods and compositions for managing vascular conditions using miR-483 mimics and HIF-1α pathway inhibitors [53]. Calcific aortic valve disease (CAVD) is a major cause of death in the aging population. Surgical valve replacement is currently the sole treatment option. Although the histological features of CAVD are similar to those observed in vascular atherosclerosis, traditional atherosclerosis treatments, such as lipid-lowering therapy with statins, are not satisfactory. This disclosure relates to miRNA-483 and its target genes, UBE2C, pVHL, and HIF-1α, which can be targets for the treatment of cardiovascular and inflammatory diseases. The inventors found that UBE2C was upregulated by d-flow in human aortic valve endothelial cells in a miR-483–dependent manner. The miR-483 mimic, which is a double-stranded nucleobase polymer, protected against endothelial inflammation and endothelial-mesenchymal transition in the cells and calcification of porcine aortic valve leaflets by downregulating UBE2C, and the HIF-1α inhibitor, PX478, significantly reduced porcine aortic valve calcification in static and d-flow conditions [54].
An analysis of the cost-effectiveness of transcatheter mitral valve repair for people with secondary mitral valve regurgitation in the UK
Published in Journal of Medical Economics, 2020
Judith Shore, Joel Russell, Lutz Frankenstein, Pascal Candolfi, Michelle Green
Costs of the TMVr procedure were micro costed as detailed in Table 4 and included in the model for MitraClip. Pre-procedural costs and peri-procedural costs were included and micro-costed based on data obtained from NHS reference costs44. The cost of an initial stay in hospital including intensive care was included in addition to procedure costs based on length of stay data reported in the EVEREST I/II study (single arm studies examining the impact of MitraClip in high-risk surgical patients with Functional or Degenerative MR)60. Length of stay information was not available from COAPT. A one-off cost for discharge to a rehabilitation facility was also included for a proportion of patients based on data from the ACCESS-Europe trial, an observational study of MitraClip conducted in Europe54. The cost of hospitalization was obtained from NHS reference costs 2017/18 using the cost of a non-elective long stay for heart failure or shock. The cost of a repeat intervention with TMVr was assumed to be equal to the cost of the initial procedure (including the additional length of stay and discharge costs). MV surgery costs were estimated using costs from NHS reference costs for a cardiology consultation, cardiac surgery consultation, and cost of a heart valve replacement or repair procedure. Discharge costs for a rehabilitation facility were also included for a proportion of patients undergoing follow-up MV surgery. As MitraClip is already in use, no additional time or impact on efficacy for learning how to undertake TMVr was included.