Page 25 - SFHN Feb 2021
P. 25

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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