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Benoy Shah MD

9 Oct, 10 tweets, 9 min read

@EACTS

#EACTS2020 update

Abstract - MV repair or replacement in the elderly? Presented Friday

I was interested in this as I too have often wondered if repair is "necessary" or "correct" in the older patient

@EACTS @BrHeartValveSoc @SCTSUK @ctsnetorg @escardio @global_wic @TheBJCA

Retrospective study of patients age >70 undergoing minimal invasive MV repair or replacement

Propensity match scoring to balance differences in baseline characteristics

Mean age 76yrs
Good LV in >80%
AF in >50%

30-day mortality 1% for repair vs 3.6% for MVR...but p=0.4

>1 major complication seen in 12% MV repair vs 17% for MVR...but p=0.27

Repair associated with shorter ICU and hospital stay

After propensity match scoring, the authors found no difference in 1yr outcome

The authors conclude that maybe we should lower the threshold for replacement...discuss!!

My thoughts below...

#EACTS2020 cardiac commentary!

I think this is a REALLY interesting & important question, but I am thinking more of >80yrs group... those that you think you can *probably* get through 1 sternotomy but, if they have premature failure & recurrent MR, unlikely fit for redo surgery

I worry about the mortality & complications signal here for MVR versus repair; p value may not have reached statistical significance simply due to inadequate sample size

Would be good to know longer term outcomes too. So, let's finish with a poll!! Go to next message 👇

82yr old lady, 70kg, generally reasonable health, mildly frail. PMVL prolapse, severe MR. LV fine. You think she's a surgical candidate. She says " Dr, I could only do this once, so whatever operation you do, please try to make it a success!!"

What do you do?

@M_Pompeu_Sa_MD

@M_Pompeu_Sa_MD @pomyers @dompagano @VictorDayan1 @mariovar55 @ovidiogarciav @Chestcracker @MadalinaGarbi @JGrapsa @SABOURETCardio @JessicaLuc1 @MMarinCuartas @difersan2 @iamritu @purviparwani @SineadHughes19 @brwcole @RODRIGOVISCONT1

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More from @dr_benoy_n_shah

Benoy Shah MD

@dr_benoy_n_shah

10 Oct

@EACTS

#EACTS2020 Update!

What a busy day! Great session related to TAVI and discussion of low risk patients and insights from the 🇺🇸 TVT database containing results from over 330,000 patients! Read more below... warning, long but interesting (hopefully!) thread...
@EACTS @SCTSUK

First presentation included 2yr outcomes from PARTNER 3 trial from Dr Vinod Thourani 👇

We were reminded of the 1year results presented last year at ACC

Significant difference in composite 1o EP at 1yr, endpoint was death / stroke / rehospitalization

At 2 yrs, similar results for this composite EP

Read 27 tweets

Benoy Shah MD

@dr_benoy_n_shah

10 Oct

@EACTS

#EACTS2020 Update

Abstract - PERSIST-AVR RCT

Well, had to choose this! Not often there's a RCT in heart valve disease!

Study: Perceval sutureless valve vs a stented tissue aortic valve, both by full sternotomy and mini sternotomy approaches

@EACTS @BrHeartValveSoc

47 sites across 3 continents recruiting from 2016-2018

578 underwent isolated AVR

Mean age 75yrs

Authors report quicker surgery and better outcomes for the Perceval valve *in combination with* mini-sternotomy approach

Read 9 tweets

Benoy Shah MD

@dr_benoy_n_shah

9 Oct

@SCTSUK

#EACTS2020

Important 🇬🇧 data on mitral valve repair over a 15 year period, from 2002/03 - 2015/16
(Presented yesterday)

@SCTSUK @ctsnetorg @HeartValveOrg @BrHeartValveSoc @escardio @EACTS @BritishCardioSo

Over past 15yrs, the number of MV operations has increased and % performed as repair has also increased...

Repair rate in ELECTIVE mitral surgery is ⬆️

Recently, the repair rate in URGENT and EMERGENCY mitral surgery has ⬇️ slightly

Read 7 tweets

Benoy Shah MD

@dr_benoy_n_shah

8 Oct

@EACTS

#EACTS2020

Starting now - Focus session on Challenges in TAVI in patients with >1 cardiac problem!

TAVI & CAD
TAVI & MR
TAVI & TR

Great talks, tune in now! 😁

@EACTS @VictorDayan1 @BCIS_uk @kaschenke @M_Pompeu_Sa_MD @EulertJ @dompagano @MadalinaGarbi @JGrapsa @doconmoney

TAVI and Coronary Disease

Such a difficult topic! No RCTs. What do you do in these patients?

And, if your patient needs revascularization, do you *ever* do PCI and TAVI in the same procedure?

Read 4 tweets

Benoy Shah MD

@dr_benoy_n_shah

21 Sep

@BrHeartValveSoc

**VALVE CASE OF THE WEEK**

OK, this starts off about valves...but then isn't really about valves...but it's the broader educational point (which is relevant to valves) that I want to make this week...no poll I'm afraid, but as always, comments encouraged! 😁

@BrHeartValveSoc

In my office doing Admin, lot to get through & a very busy morning ahead. Asked to r/v a TTE for helping determine AS severity. Pt admitted with heart failure, clinically severe AS is all I know at this point. Now, the golden rule in this situation is *review the whole study*...

Not just one or two images.

But I was super-busy, I BROKE MY OWN RULE and just looked at the relevant images. Here's the PW and CW Doppler tracings (Pt in AF)...

Read 15 tweets

Benoy Shah MD

@dr_benoy_n_shah

19 Aug

**VALVE CASE OF THE WEEK**

In our hospital, we have seen 2 patients over the past 3 years that presented with acute heart failure and who had severe AR on echo with large, characteristic masses on the AV. This week's poll is simply... what do you think these masses are? (1)

Patient 1 - Female, early 60s, no major PMHx, admitted with 2 weeks worsening SOB and palpitations. No fever. In heart failure, BP 110mmHg systolic. AR murmur. Normal white cell count & near normal CRP on bloods. TTE below...zoomed PLAX view of AV (2)