Page 25 - SFHN Feb 2021
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Cardiology
Minimally Invasive Aortic Valve Replacement Risks
Are Overestimated, Says Miller School Study
BY RICHARD WESTLUND Innovations, the journal of gery for many patients, including shorter
the International Society for length of stay and recovery time, greater
Minimally invasive aortic valve replace- Minimally Invasive Cardio - satisfaction, less renal failure, and better
ment (AVR) surgery is a safer procedure thoracic Surgery (ISMIC). postoperative respiratory function,” said
than indicated by current surgical risk “I think physicians can Dr. Lamelas. “That can lead to faster
scores, according to Joseph Lamelas, M.D., reassure people that their risk recovery and better survival, as well as less
chief and program director of cardiotho- scores are over predicting operative blood loss and fewer transfu-
racic surgery at the University of Miami their outcomes. The risk sions. Increasingly, patients themselves are
Health System. score by itself doesn't matter requesting minimally invasive procedures
“Surgical risk scores are designed to as long as patients receive because of these potential benefits.”
help physicians and patients evaluate their appropriate care by experi- Dr. Lamelas added that risk scores for
options,” said Dr. Lamelas. “However, Dr. Joseph Lamelas enced teams.” said Ahmed AVR procedures may change as more car-
they overestimate the risk for minimally Alnajar, M.D., co-researcher diac surgeons adapt the minimally inva-
invasive aortic valve replacement (Mini- RS), and age, creatinine, and ejection frac- and quality management analyst at the sive approach. “Currently, only about 20
AVR) procedures through a mini thoraco- tion score (ACEF). Department of Surgery, University of percent of AVR cases in the U.S. are done
tomy, which can provide better outcomes They compared each score’s accuracy by Miami. with the minimally invasive approach,” he
and faster recoveries than open-heart sur- computing the observed-to-expected 30- For more than a decade, cardiac sur- said. For more than a decade, Dr. Lamelas
geries through the sternum.” day mortality ratio, and found each of the geons have performed mini-AVR proce- has trained other cardiac surgeons in min-
After analyzing 1,018 low-risk patients scoring systems over-predicted mortality dures to replace a diseased aortic valve imally invasive techniques, including vir-
undergoing surgery for aortic stenosis, by two or three times, said Dr. Lamelas. that becomes obstructed or leaks blood tual sessions in the past year.
Dr. Lamelas and his collaborative Dr. Lamelas was the head of the from the heart. Patients are typically “Once surgeons get past the learning
research team looked at the four avail- research group, senior author, and the evaluated for surgical risk, based on fac- curve, they find there are clear benefits for
able risk scoring systems: Society of surgeon performing all the operations tors that include age, physical condition their patients,” he said. “Meanwhile, we
Thoracic Surgeons Predicted Risk of included in the study, “Current Surgical and chronic problems, such as hyperten- need to develop alternative dedicated scor-
Mortality (STS-PROM), European System Risk Scores Overestimate Risk in sion, kidney or lung disease. ing systems for mini-AVR to help our
for Cardiac Operative Risk Evaluation Minimally Invasive Aortic Valve “Mini-AVR has significant advantages patients make more accurate outcome
(EuroSCORE) II, TAVR Risk Score (TAVR- Replacement,” published in December in over conventional, sternotomy-based, sur- assessments.”
Cover Story: COVID-19 Shown to Affect Cardiovascular System in Short- and Long-term
Continued from page 1 because their hearts can’t pump blood Those who suffer from other cardiac people to determine the safety of a vac-
effect, causing a drop in blood pressure, effectively.” conditions need to be especially careful, cine, and the initial COVID-19 vaccine
hypoxia (low oxygen in the blood), and Even those who recover from COVID- as it has been reported that patients with trials have included between 30,000 and
an increase in the tendency to create 19 need to be aware of the long-term high blood pressure and heart disease are 40,000 people.
blood clots. effects, which can include residual more prone to develop complications “That’s very good data in terms of safe-
“In the third case, because of the pan- inflammation of the heart. from the virus. ty,” he explained. “While the rollout has
demic, we have seen a decrease in the “This is very important because a lot of “There is no doubt that there are cer- been challenging, keep checking with
number of people coming to the hospital people who had COVID didn’t go to the tain cardiac conditions that make your healthcare provider until you can
because they fear contracting the virus,” hospital—they stayed at home until they patients more susceptible to complica- get the vaccination.”
said Brenes. “A lot of people are thinking were better,” said Dr. Brenes. “But they tions from the virus, though not neces- Dr. Brenes added that studies on flu
twice before going to the ER and seeking should still definitely speak with their sarily to get infected by the virus,” said vaccinations have shown that these vac-
attention even when they are having doctors about whether they need to see a Dr. Brenes. “For example, while patients cinations reduce the risk of hospitaliza-
heart attacks; by the time they come to cardiologist. with previous cardiovascular issues who tion for heart disease, as well as pneumo-
the hospital, it’s too late.” “For example, athletes need to be get the virus may present with high nia.
While most of the symptoms of the cleared before they go back to participat- blood pressure, it doesn’t mean that “I’m looking forward to seeing studies
virus are usually respiratory, and can ing in competitive sports because of the every person with hypertension is prone about the potential implications of the
include cough, shortness of breath, chills possibility of long-term effects that could to develop COVID-19.” COVID-19 vaccine reducing cardiac-
and fever, it can also cause tachycardia (a lead to other problems,” he added. Whether people have previous cardio- related COVID-19 complications,” he
faster heartbeat). “We’ve seen studies on young people vascular conditions or not, Dr. Brenes said. “I’m very optimistic about the posi-
“In mild cases, it can cause palpita- who have suffered from COVID-19, and has one very important piece of advice. tive effects of the vaccine not only in
tions, and in moderate cases, it will have even two months later, there is still evi- “Go get vaccinated,” he said. “That’s reducing the chances of getting severe
a more pronounced effect on breathing,” dence of heart inflammation. This type of the bottom line.” COVID-19, but of reducing the chances
said Dr. Brenes. “Patients may experience situation can cause problems for compet- According to Dr. Brenes, the FDA of complications after contracting the
full cardiogenic shock in severe cases itive athletes or anyone else.” needs to enroll between 3,000-5,000 virus. It gives me a lot of hope.”
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