If someone has already lived far past the average life expectancy in their country and is now into their 90s, can we *promise* the patient that TAVI will make them live longer?
In our centre, we feel that patients >90 need to be very motivated to have a procedure
So, the conclusion was that nonagenarians should not be denied TAVI on lack of prognostic benefit grounds
My thought is...what if high gradient severe AS but no symptoms? In our centre, an asymptomatic pt >90 would not get TAVI...what would you do in your hospital?
Next talk from @Claudmuneretto on the important issue of patients with small aortic annuli - should they have a sutureless / rapid deployment valve or a TAVI?
A single-centre retrospective analysis of 28 patients
Main reason for re-intervention was endocarditis - important to remember this, TAVI valves are biological valves and they get infected too, just like surgical bioprostheses
Median time from TAVI to AVR was just 7 months...I guess some of these valves may have had bacterial entry into the body at the time of the TAVI procedure?
Mean age ~73-75yrs
Here are physical & mental recovery slides - I interpreted the 6MWT graph as this being greater for SAVR than TAVI? Unsure if y axis is change (delta) in 6MWT distance or absolute distance...
Must commend the speaker for including a limitations slide; very important to acknowledge this for these retrospective studies in which inevitably there will be biases that cannot be corrected, even by PSM!
In my hospital, we only use GA for the rare transapical case or for TF cases where surgical cut-down is needed or other reasons like patient would not tolerate sedation / LA approach
Final presentation on the Royal Brompton's experience using the Tendyne TMVI system - hope you saw my thread last night on the TMVI session, so you should be up to speed with what this is! 😀
Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.
A worked example below:
In the PLAX view, you can assess the scallops of the leaflets
In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface
Here, you can see the valve looks slightly different & no prolapse is seen
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively ⬇️ costs whilst ⬆️ profit margins, leverage debt if needed, and then sell, often at a large profit
Does this matter when it comes to delivering healthcare services?
Sixty years ago this month - October 1963 - US cardiologist Dr Robert Bruce published a paper detailing his efforts to devise a multi-stage treadmill test
Little did he know this would go on to become the Bruce protocol the most widely used for exercise testing
A thread...
Prior to this, 'stress testing' to evaluate cardiac function was performed using the Masters 2-step technique, first described in 1935. This crude but simple test involved repeated steps up & down over 90 seconds
Bruce, amongst others, recognized the limitations of this test & set about developing an exercise treadmill test
His initial work focused upon a single stage protocol, but he soon realized this wasn't stressing fitter patients enough & the test was taking too long!
We know now that it is perfectly possible for symptomatic individuals to have abnormal stress tests, with inducible ischaemia, but not have significant epicardial CAD on angiography
So we should stop using epicardial CAD as the arbiter of whether the test is 'right' or 'wrong'
I helped recruit patients for #ISCHEMIA between 2012-13; we saw at least a dozen patients with barn door (core lab verified) abnormal stress tests but normal coronaries on angiography
Here is just one example! Rest on left, stress (exercise) on right...
Today – July 5th 2023 – marks exactly 75 years since the National Health Service (NHS) was established in 🇬🇧
Long admired around the 🌍for its free-at-the-point-of-care principle, today the NHS is itself on life support
Let us remind ourselves how the NHS came to be
#NHS
1/
The establishment of the NHS was the culmination of attempts to provide healthcare services to Britain’s citizens for at least a century
The designers of the NHS did not start with a clean slate - the service was a rationalisation of services that already existed
#NHS75
2/
In the early 20th century, medical wards were full of patients with pneumococcal pneumonia, lung abscess, acute nephritis, rheumatic heart disease, TB, syphilis & brucellosis. Treatment was often based on good nursing & bed rest with barbiturate sedation at night.