Category: Surgeries & Procedures

Categories : Cardiovascular Disease Surgeries & ProceduresTags :

Troponin Levels Help Inform When to Perform Surgery after Heart Attack

On By ModernMedia
Photo by Natanael Melchor on Unsplash

New research from a large study published in the International Journal of Cardiology shows that timing of surgery for some heart attack patients can be improved by analysing troponin levels.

Troponin is a protein involved in muscle contraction that is released into the bloodstream after heart attack, with higher levels indicating more heart damage. Troponin levels help clinicians to determine whether a patient is having a heart attack, or myocardial infarction (MI), and to decide on treatment options such as coronary artery bypass graft (CABG) surgery.

The optimal time to perform surgery following an MI remains unclear. Previous reports have suggested that carrying out surgery in the first few days following an MI is associated with a higher risk of surgical complications and death by not leaving time for the heart to recover. As a result, following an MI, many patients who need bypass surgery wait for more than 10 days before surgery is performed.

Researchers in this study found that some patients who have lower levels of troponin would benefit from having earlier surgery. However, the researchers show that patients with very high troponin levels should have surgery postponed, as their risk of dying was higher if surgery was performed within 10 days of their MI.

There was no benefit in delaying surgery for those with low levels of troponin, according to the study.

Early surgery for MI patients

The researchers suggest that early surgery for MI patients with lower troponin levels would reduce overall length of stay and ease pressure on resources such as staff.

This is the first multicentre study to investigate the interaction between the extent of heart damage, as indicated by troponin levels, and the optimal time to wait for surgery in a large series of MI patients. 

Dr Amit Kaura, lead author of the research, said: “The approach on the safest time to operate on patients following a heart attack varies in hospitals across the UK. Our study could help clinicians make more informed decisions on the best treatment plans for heart attack patients requiring surgery, based on their levels of troponin. It could also lead to a more standardised approach in the NHS on how we treat this patient group, leading to resources being used effectively, shorter stays and improved outcomes for patients.”

The study reviewed patients who had a non-ST segment elevation myocardial infarction (NSTEMI) due to a blockage to their coronary arteries who required a CABG.

About 20% of NSTEMI patients have a CABG. The optimal timing for CABG surgery in patients with uncomplicated NSTEMI has been unclear. Prior to the new research, some studies had suggested that early surgery was associated with higher mortality post operation. This has led to a tendency for CABG to be delayed if a patient’s condition remains stable. However, other studies had reported similar mortality rates after early versus late surgery, concluding that delaying surgery in all patients after uncomplicated NSTEMI is not warranted and does not improve outcomes. No previous study had investigated in a large group of patients whether there was an association between the extent of heart damage (as measured by troponin levels) and the wait for surgery on survival.

Heart data insights

The team analysed data from the NIHR HIC of 1746 patients with NSTEMI and unstable angina (UA) where insufficient cardiac blood supply leads to an MI. The cohort consisted of 1684 patients with NSTEMI and 62 with UA. The average age of the group was 69 and 21% were female. They underwent CABG within 90 days at one of five cardiac centres before their surgery between 2010 and 2017. 

The researchers compared patients’ troponin levels, wait between surgery and outcomes after surgery within the first 30 days and over a period of five years. Pre-operative troponin level strongly predicted early mortality, and this was significantly influenced by the interval to surgery. The average wait for patients with high troponin levels to surgery was nine days. Sixty patients died within 30 days after surgery and another 211 patients died over a period of five years following surgery. They found that for those who had troponin levels of less than 100 times the normal upper limit, delaying surgery to after 10 days was not associated with lower survival. For patients with higher troponin levels, early survival increased progressively with a longer time to surgery – survival was highest in those who had surgery after day 10. 

Dr Amit Kaura said: “For patients with troponin levels of under 100 times the normal upper limit, extending the waiting time or surgery did not improve early survival. This finding is particularly significant as two-thirds of patients presenting with troponin levels of under 100 are waiting on average 12 days for surgery after being admitted to hospital. There are potential cost saving implications with our research by performing earlier surgery in this group of patients with lower troponin levels”.

The effect of troponin levels pre-operation on survival was limited to the first 30 days after surgery. Late survival was determined by other risk factors, such as age and other co-morbidities such as hypertension.

Further studies are needed in the form of prospective trials to assess the impact of troponin and timing of surgery on survival following a heart attack, the researchers say.

Source: Imperial College London

Categories : Surgeries & ProceduresTags :

Remove All Secondary Kidney Stones, Study Suggests

On By ModernMedia
Anatomic model of a kidney
Photo by Robina Weermeijer on Unsplash

A new study showed, during kidney stone removal procedures, leaving small asymptomatic stones behind significantly increases the risk of a patient’s relapse in the following five years. The study findings appear in the New England Journal of Medicine.

Typically, stones < 6mm in diameter that are not a procedure’s primary target are not removed but monitored, since ‘secondary’ stones have high rates of successful passage if they move into the ureter, explained Dr Mathew Sorensen, a urologist at the University of Washington School of Medicine and the study’s lead author.

“Before this study, the clinical views were pretty mixed on whether some of these stones should be treated,” he said. “Most clinicians would decide, based on the size of the stone, whether it hit the bar for treatment, and if it did not, you would often ignore the little stones.”

The researchers studied 75 patients who were treated at multiple institutions over 2015 to 2021. About half of the patients had only their large primary stone treated, while the others had primary and secondary stones removed. Relapse was defined as having to go to the emergency room or undergo an additional procedure due to a recurrence or if a follow-up CT scan showed that the secondary stones grew.

Removal of the secondary stones reduced the relapse rate by 82%, the researchers found, leading the authors to recommend that smaller stones should not be left behind.

“Results of our trial support the removal of small asymptomatic renal stones at the time of surgery with a larger stone,” their paper concluded. The authors noted that while removal of smaller stones could add to the procedure’s duration and cost, those costs would likely be less than those associated with a patient’s repeat procedure or visit to the emergency room. Some patients in the study visited the emergency department multiple times and then required surgery, the report noted.

Dr Sorensen said he would share the study results with colleagues with the hope of changing their sensibility toward smaller stones. Further study is needed to determine whether treatment of small stones alone is justified, as technology improves and the costs and risks of intervention diminish, he said.

“I think we have proven through this rigorous study that removal of the small asymptomatic stones is beneficial when feasible and in patients that are candidates to have all their stones treated in one procedure,” he noted. “Leaving the stones behind risk trouble in the future.”

Source: University of Washington School of Medicine/UW Medicine

Categories : Surgeries & ProceduresTags :

Regenerating Muscles for Better Rotator Cuff Repair

On By ModernMedia
Photo by Harlie Raethel on Unsplash

Researchers have pioneered a technique way to regenerate muscle that could help encourage muscle growth in damaged rotator cuff muscles and aid in their repair. Their findings are available to read online in the Proceedings of the National Academy of Sciences.

Tears of the major tendons in the shoulder joint, commonly called the rotator cuff, are common injuries in adults. Improved rotator cuff repairs are now possible with surgical advances, though failure rates with surgery can still be high.  Now, a team of researchers from the UConn School of Medicine led by surgeon, engineer and scientist Dr Cato T. Laurencin reported that a graphene/polymer matrix embedded into shoulder muscle can prevent re-tear injuries.

“Most repairs focus on the tendon,” and how to reattach it to the bone most effectively, Laurencin says. “But the real problem is that the muscle degenerates and accumulates fat. With a tear, the muscle shrinks, and the body grows fat in that area instead. When the tendon and muscle are finally reattached surgically to the shoulder bone, the weakened muscle can’t handle normal stresses and the area can be re-injured again.

The researchers developed a polymer mesh infused with nanoplatelets of graphene. When they used it to repair the shoulders of rats who had chronic rotator cuff tears with muscle atrophy, the muscle grew back. When they tried growing muscle on the mesh in a petri dish in the lab, they found the material seemed to encourage the growth of myotubes, precursors of muscle, and discourage the formation of fat.

“This is really a potential breakthrough treatment for tears of the rotator cuff. It addresses the real problem: muscle degeneration and fat accumulation,” Dr Laurencin said.

The next step in their work is studying the matrix in a large animal. The team looks forward to developing the technology in humans.

Source: University of Connecticut

Categories : Cardiovascular Disease Surgeries & ProceduresTags :

Aspirin and Antiplatelets after Coronary Artery Grafts are a Double-edged Sword

On By ModernMedia
Source: Wikimedia Commons CC0

A new analysis published in JAMA shows that a combination of aspirin and another antiplatelet agent can prevent clotting after coronary artery bypass grafts but also increases the risk of potentially dangerous bleeding. This double-edged finding from investigators suggests physicians should carefully weigh the use of these medications after this procedure.

A Weill Cornell Medicine and NewYork-Presbyterian team led by Dr Mario Gaudino, a coronary artery bypass surgeon, examined data from 1668 grafts in which surgeons use a saphenous vein graft to circumvent blocked coronary arteries. It is common for blood clots to form within the grafted vein, for which patients are typically given aspirin. Some evidence suggests that aspirin along with a prescription strength antiplatelet agent such as ticagrelor can more effectively prevent this clotting.

“We found that, yes, this dual therapy significantly reduces the risk that the grafts will fail. However, for the first time, we have shown that this approach also carries a significant risk of clinically important bleeding,” said Dr Gaudino. “So, the benefit comes at a price.”

Taken together, these results indicate physicians should base their decisions on patients’ individual circumstances and avoid using this approach for those with conditions that put them at risk of bleeding, he said.

In more than 90% of coronary artery bypass grafts, surgeons take a graft from one of the patient’s saphenous veins, which return blood up the leg. However, within a year, up to a quarter of these grafts become obstructed.

While studies have examined the benefit of aspirin and ticagrelor, known as dual antiplatelet therapy (DAPT), these studies were small and had conflicting conclusions. The team contacted researchers on four such trials to obtain access to their raw data. They aggregated the data and effectively created a much larger study capable of generating more robust conclusions.

They found a failure rate of approximately 11% in patients who received a combination of aspirin and ticagrelor, while blockages occurred in 20% of grafts when patients received only aspirin. However, compared to aspirin alone, DAPT brought on more bleeding events that, while generally not life threatening, required medical attention.

In these previous trials, patients received DAPT for a full year. However, most graft failure occurs in the first few months after surgery. Dr Gaudino plans a further test of aspirin and ticagrelor over one to three months to see if a shortened course offers the same benefit with less risk of bleeding.

Source: Weill Cornell Medicine

Categories : Cardiovascular Disease Surgeries & ProceduresTags :

Post-operative AF Linked to Risk of Hospitalisation for Heart Failure

On By ModernMedia
Associations between post-operative atrial fibrillation and incident heart failure hospitalisations. Credit: European Heart Journal

A study of over three million patients found that people who develop an atrial fibrillation (AF) after undergoing surgery have an increased risk of subsequent hospitalisation for heart failure.

The study, which is published in the European Heart Journal, showed that the risk of hospitalisation for heart failure among patients who developed AF after surgery increased regardless of whether or not the surgery was for a heart condition.

Among 76 536 patients who underwent heart surgery, 18.8% developed post-operative AF and the risk of hospitalisation for heart failure increased by a third compared to patients who did not develop AF. Among 2 929 854 patients without a history of heart disease who had surgery for non-heart-related conditions, 0.8% developed AF and the risk of hospitalisation for heart failure doubled.

The study’s first author, Dr Parag Goyal, Associate Professor of Medicine at Weill Cornell Medicine, said: “Our study, which to our knowledge is the largest study to date, shows that post-operative atrial fibrillation is associated with future heart failure hospitalisations. This could mean that atrial fibrillation is an important indicator of underlying but not yet detected heart failure; or it could mean that atrial fibrillation itself contributes to the future development of heart failure. While this study could not specifically address which of these mechanisms are at play, our hope is that this study will inspire future work into exploring the underlying mechanism seen in our important findings.

“Regardless of the mechanism, our study shows that post-operative atrial fibrillation is clearly an important entity that merits attention and incorporation into decision making. Most importantly, patients and doctors need to be more vigilant about heart failure symptoms among patients who develop post-operative atrial fibrillation. Those who do develop the condition may require more aggressive treatments for other risk factors for heart failure, such as high blood pressure, diabetes and narrowing of the arteries.”

Post-operative AF occurs in up to 40% of patients undergoing heart surgery and 2% of patients undergoing non-cardiac surgery. Doctors have tended to view it as a benign event, triggered by the stress of the surgery – but evidence is emerging that post-operative AF is linked to longer term problems such as stroke and death from any cause. Until now, there has been limited evidence regarding its association with subsequent heart failure.

For the current, retrospective study, the researchers collected data on hospital health claims from 2016 to 2018, adjusting for factors that could affect the results such as age, sex, race, insurance status, medical history and body mass index.

Study limitations include its observational nature which can only establish association, not causation. The study relies on administrative claims data and medical codes to identify medical conditions; it lacks more detailed information like management strategies for post-operative AF, and on the function and size of the left ventricle, which could affect the likelihood of developing AF.

The researchers hope to conduct further studies to understand the underlying mechanism and to investigate ways of preventing future hospitalisations for heart failure among patients who develop post-operative AF.

The researchers wrote in the conclusion that “In the meantime, clinicians should be aware that POAF [post-operative AF] may be a harbinger of HF.”

In an accompanying editorial, Dr Melissa Middeldorp and Professor Christine Albert, both from the Smidt Heart Institute at Cedars-Sinai, California, USA, write: “These data add to a growing body of literature suggesting that POAF is not just a transient response to surgery but may be reflective of underlying atrial and myocardial structural changes that not only predispose to the acute AF event but to other potentially related adverse cardiovascular events, such as HF hospitalisation.”

They write that further studies are needed for a better understanding of the mechanisms involved in placing people at greater risk of AF and post-operative heart failure is needed in order to reduce hospitalisation and deaths after surgery.

“With a greater understanding of patients’ full risk factor profile, we may advocate for early aggressive intervention at the initial manifestation of POAF, to improve outcomes and reduce rehospitalisation following cardiac and non-cardiac surgery,” they concluded.

Source: European Society of Cardiology

Categories : Surgeries & ProceduresTags :

AI-enabled Kidney Surgery Makes it Easier for Novice Surgeons

On By ModernMedia
Anatomic model of a kidney
Photo by Robina Weermeijer on Unsplash

Percutaneous nephrolithotomy (PCNL) is an efficient surgical intervention for removing large kidney stones. However, it is a challenging procedure that requires years of training to perform. To address this, a group of scientists from the Nagoya City University, developed and trialled an artificial intelligence (AI)-enabled robotic device for assisting surgeons in PCNL.

Creating a renal access from the skin on the back to the kidney is a crucial yet challenging step in PCNL. A poorly performed renal access can lead to severe complications including massive bleeding, thoracis and bowel injuries, renal pelvis perforation, or even sepsis. This procedure takes years of training to master. The two main renal access methods for PCNL – X-ray guidance and ultrasound (US) guidance deliver similar postoperative outcomes but require experience-based expertise.

Many technologies are being developed to bridge this skill gap. This inspired a Nagoya University research team to question if artificial intelligence (AI)-powered robotic devices could be used for improved guidance compared with conventional US guidance. Specifically, they wanted to see if the AI-powered device called the Automated Needle Targeting with X-ray (ANT-X), which was developed by the Singaporean medical start-up, NDR Medical Technology, offers better precision in percutaneous renal access along with automated needle trajectory.

The team performed a randomised, single-blind, controlled trial comparing their robotic-assisted fluoroscopic-guided (RAF) method with US-guided PCNL. The results of this trial were detailed in the The Journal of Urology. “This was the first human study comparing RAF with conventional ultrasound guidance for renal access during PCNL, and the first clinical application of the ANT-X ,” said Dr Kazumi Taguchi, Assistant Professor at NCU.

The trial was conducted with 71 patients—36 in the RAF group and 35 in the US group. The primary outcome of the study was single puncture success, with stone-free rate (SFR), complication rate, parameters measured during renal access, and fluoroscopy time as secondary outcomes.

The single puncture success rate was ~34 and 50% in the US and RAF groups, respectively. Fewer needle punctures were needed in the RAF group (1.82 times) as opposed to the US group (2.51 times). In 14.3% of US-guided cases, the resident was unable to obtain renal access due to procedural difficulty, prompting a surgeon change. However, none of the RAF cases faced this issue. The median needle puncture duration was also significantly shorter in the RAF group (5.5 minutes vs 8.0 minutes). No significant differences in the other secondary outcomes was found.

Multiple renal accesses during PCNL are directly linked to postoperative complications including, decreased renal function. Therefore, the low needle puncture frequency and shorter puncture duration, as demonstrated by the ANT-X, may provide better long-term outcome for patients. While the actual PCNL was performed by residents in both RAF and US groups, the renal access was created by a single, novice surgeon in the RAF group, using ANT-X. This demonstrates the safety and convenience of the novel robotic device, which could possibly reduce surgeons’ training load and allow more hospitals to offer PCNL procedures.

Dr Taguchi commented, “The ANT-X simplifies a complex procedure, like PCNL, making it easier for more doctors to perform it and help more number of patients in the process. Being an AI-powered robotic technology, this technique may pave the way for automating similar interventional surgeries that could shorten the procedure time, relieve the burden off of senior doctors, and perhaps reduce the occurrence of complications.”

Source: Nagoya City University

Categories : Cancer Surgeries & ProceduresTags :

Bariatric Surgery Reduces Cancer Risks with Obesity

On By ModernMedia
Obesity
Image source: Pixabay CC0

A study published in JAMA shows that weight loss through bariatric surgery for adults with obesity was associated with a 32% lower risk of developing cancer and a 48% lower risk of cancer-related death compared with those who did not have the surgery.

Rising obesity numbers are being seen all over the world. The International Agency for Research on Cancer describes 13 types of cancer as obesity-associated cancers such as endometrial cancer, postmenopausal breast cancer, and cancers of the colon, liver, pancreas, ovary and thyroid.

Lead author of the study, Ali Aminian, MD, at Cleveland Clinic, said that bariatric surgery is currently the most effective treatment for obesity. “Patients can lose 20 to 40% of their body weight after surgery, and weight loss can be sustained over decades. The striking findings of this study indicate that the greater the weight loss, the lower the risk of cancer,” said Dr Aminian.

From 2004 and 2017, the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) study matched a group of 5053 adult patients with obesity who had bariatric surgery 1:5 to a control group of 25 265 patients with obesity who did not undergo the surgery.

After 10 years, 2.9% of patients in the bariatric surgery group and 4.9% of patients in the non-surgical group developed an obesity-associated cancer.

After 10 years, 0.8% of patients in the surgery group and 1.4% of patients in the non-surgical group died from cancer, indicating that bariatric surgery is associated with a 48% lower cancer mortality risk.

Researchers noted that the benefits of bariatric surgery were seen in a wide range of study participants in terms of age, sex and race. In addition, benefits were similarly observed after both gastric bypass and gastric sleeve operations.

“According to the American Cancer Society, obesity is second only to tobacco as a preventable cause of cancer in the United States,” said the study’s senior author, Steven Nissen, MD, Chief Academic Officer of the Heart, Vascular and Thoracic Institute. “This study provides the best possible evidence on the value of intentional weight loss to reduce cancer risk and mortality.”

Numerous studies have shown the health benefits of bariatric or weight-loss surgery in patients with obesity. The Cleveland Clinic-led STAMPEDE study showed that following bariatric surgery, significant weight loss and control of type 2 diabetes last over time. The SPLENDOR study showed that in patients with fatty liver, bariatric surgery decreases the risk of the progression of liver disease and serious heart complications.

The SPLENDID study adds important findings to the literature focused on the link between obesity and cancer. Given the growing epidemic of obesity worldwide, these findings have considerable public health implications.

“Based on the magnitude of benefit shown in our study, weight loss surgery can be considered in addition to other interventions that can help prevent cancer and reduce mortality,” said Jame Abraham, M.D., chairman of the Hematology and Medical Oncology Department at Cleveland Clinic. “Further research needs to be done to understand the underlying mechanisms responsible for reduced cancer risk following bariatric surgery.”

Source: Cleveland Clinic

Categories : Obstetrics & Gynaecology Surgeries & ProceduresTags :

Audit Finds Women are Uninformed of Common Anaesthetic’s Effect on Contraception

On By ModernMedia

Women undergoing operations are not being routinely informed that a common anaesthetic may reduce their contraception’s effectiveness, putting them at risk of an unplanned pregnancy, suggests new research which is being presented at Euroanaesthesia, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC).

The drug sugammadex is widely used in anaesthesia.  Administered towards the end of the operation, ahead of waking the patient up, it reverses the action of the neuromuscular blocking drugs rocuronium and vecuronium given earlier in the procedure to relax the patient’s muscles.

Sugammadex is known to interact with progesterone, possibly reducing the effectiveness of hormonal contraceptives, including the progesterone-only pill (mini-pill), combined pill, vaginal rings, implants and intra-uterine devices.

Current guidance is to inform women of child-bearing age (WCBA) that they have received the drug and, due to increased risk of contraceptive failure, advise those taking oral hormonal contraceptives to follow the missed pill advice in the leaflet that comes with their contraceptives and advise those using other types of hormonal contraceptive to use an additional non-hormonal means of contraception for seven days.

However in the experience of the authors, robust methods for identifying at-risk patients and informing them of the associated risk of contraceptive failures is not common practice across anaesthetic departments within the UK, and likely further afield. 

To find out more, Dr Neha Passi, Dr Matt Oliver and colleagues at the University College London Hospitals NHS Foundation Trust surveyed anaesthetists at their hospital trust on their use of sugammadex and carried out a retrospective audit of sugammadex use in the Trust.

A seven-question survey was sent to all anaesthetists at the Trust.  Including consultants, junior doctors and physician assistants, this numbered almost 150 professionals.

Of the 82 anaesthetists who responded, 94% said they were aware of the risk of contraceptive failure – but 70% of respondents reported they do not routinely discuss sugammadex with patients who received it.

During the audit, 65 WCBA patients were given sugammadex, and 48 of these should have received advice on the risks of contraceptive failure.  There was no record of it, however, in the medical notes of any of the 48 women. (The other 17’s medical history meant they weren’t at risk of pregnancy and so not eligible for the advice.)

Dr Passi said: “It is concerning that we are so seldom informing patients of the risk of contraceptive failure following sugammadex use.

“Use of sugammadex is expected to rise as it becomes cheaper in the future and ensuring that women this receiving medicine are aware it may increase their risk of unwanted pregnancy must be a priority.”

Dr Oliver added: “We only studied one hospital trust but we expect the results to be similar in elsewhere in the UK.”

Dr Passi adds: “It is important to note, however, that most patients receiving an anaesthetic do not need a muscle relaxant2 and that sugammadex is one several drugs available to reverse muscle relaxation.”

In response to their findings, the study’s authors have created patient information leaflets and letters and programmed the Trust’s electronic patient record system to identify ‘at-risk’ patients and deliver electronic prompts to the anaesthetists caring for them in the perioperative period.

Sugammadex is the only anaesthetic drug known to have this effect.

Source: EurekAlert!

Categories : Ageing Surgeries & ProceduresTags :

Progressive Exercise Programme Improves Outcomes after Hip Surgery

On By ModernMedia
Carers help an old man to walk
Photo by Kampus Productions on Pexels

A study published in the Journal of the American Geriatrics Society shows that a 12-month home-based supervised exercise programme can help to improve physical performance and functioning after patients undergo hip fracture surgery.

Hip fracture is a major health problem among older people, often resulting in long-term, sometimes persistent, functional impairments such as poor mobility and reduced independence in daily activities. Sedentary behaviour and low level of physical activity are also common among patients recovering from surgical repair of a hip fracture.

Standard care post-discharge care does not seem to meet the requirements of effective rehabilitation, as many patients with hip fractures do not reach their pre-fracture level of functioning. Growing evidence shows that multidisciplinary and well-coordinated rehabilitation started at the hospital and continued after discharge enhances the recovery of patients with hip fractures. Multicomponent rehabilitation in particular, which includes individualised and progressive resistance training, has improved functioning and mobility and decreased dependency in everyday activities. Longer lasting exercise programs of 6 to 12 months duration have reduced or reversed incident disability after hip fractures.

For the study, 121 patients aged 60 years and older were randomised to either an exercise group or a usual care group as a control. Home-based exercise sessions were delivered by physiotherapists twice a week and included strength, balance, mobility, and functional components as well as brief counselling on physical activity and nutrition.

Compared with patients in the usual care group, patients in the exercise group saw more improvements over the course of a year in their physical performance, their handgrip strength, and their ability to complete certain activities of daily living.

“It is worthwhile to invest in rehabilitation exercise for older people after hip fracture. Better functioning benefits the individual and also society,” said lead author Paula K. Soukkio, MSc, of the South Karelia Social and Health Care District (Eksote), in Finland.

Source: Wiley

Categories : Surgeries & ProceduresTags :

Earlier Valve Replacement Surgery Recommended in Aortic Stenosis

On By ModernMedia
Source: Pixabay CC0

Valve replacement surgery should be performed earlier than conventionally thought for people with aortic stenosis, as shown by new research published in the journal Open Heart.

Aortic stenosis is a common valvular disorder, especially in the elderly population, causing left ventricular outflow obstruction. Aetiologies include congenital (bicuspid/unicuspid), calcific, and rheumatic disease. Symptoms such as exertional dyspnoea or fatigue gradually develop after a long asymptomatic latent period of about 10 to 20 years. But many patients with aortic stenosis do not have symptoms even when they have severe narrowing of the valve and are thus not eligible for valve replacement.

The findings from this study show that these patients would benefit by undergoing a valve replacement – before they suffer irreversible heart muscle damage.

Lead researcher Prof Vassilios Vassiliou, from UEA’s Norwich Medical School, said: “The heart has four valves, which allow the blood to flow in one direction efficiently. With increasing age, one of the valves, the aortic valve, becomes increasingly narrowed or ‘stenosed’.

“A lot of patients with severe aortic stenosis do not have symptoms and therefore are not eligible for valve replacement according to the current guidelines.

“For these patients without symptoms, the guidelines suggest a ‘watchful waiting’ approach and intervention is recommended only when they show symptoms or develop pump failure.

“We wanted to know if it would be better to perform surgery and replace the valve sooner rather than later.”

In a systematic review, researchers compared early intervention versus conservative management in patients with asymptomatic severe aortic stenosis.

They then analysed data from all the available studies which involved a total of 3798 patients, out of which 302 were included in the two largest randomised controlled trials and 3496 in the observational studies.

Prof Vassiliou said: “We found that early intervention, before patients have symptoms, is associated with lower risk of death and hospitalisation for heart failure.

“By the time the patients develop symptoms, there has likely been irreversible damage to the muscle of the heart. This in turn may preclude a worse prognosis and adverse outcomes even after successful intervention.

“The timing of aortic valve intervention is crucial.

“We hope that our findings may herald the beginning of a change in the management of aortic stenosis patients, enabling the intervention to take place more commonly whilst the patients are asymptomatic.

“Ongoing trials investigating this high-risk population are anticipated to shed more light into the matter and in the identification of the optimal time of intervention,” he added.

Source: University of East Anglia