Transcatheter aortic valve replacement (TAVR) introduction to the clinical practice revolutionized the interventional cardiology ,it is a valuable option for a non –operable patient with sever aortic stenosis or high risk population however ,TAVR is associated with a risk of cerebral embolization and ischemic vascular events and possible neurological impairment the estimate of these complication is vary but it have been reported early and late after the procedure moreover the reported incidence of bleeding associated with TAVI is relatively high .with this given incident of complication required adequate antithrombotic therapy during and following procedure ,however despite the current guidelines recommendation the optimal antithrombotic is not very well established .
Introduction:
Sever Aortic Stenosis (AS) is a major cause of mortality and morbidity in elderly duo to a bimodal age distribution ,degenerative calcification of Tricuspid valve is the major cause of AS in the population ,unlike the younger patient etiology which is : bicuspid valve calcification or rheumatic heart disease .1
The Burden of the disease is high with a prevalence of 3.4% 2. With the progressive nature of the disease and the increased severity of the symptoms made the surgery the gold standard for symptomatic AS patients ,however up to 30% of cases are considered too high risk for classical valve replacement surgery and remain untreated and experiencing poor prognosis . Fortunately , with the introduction of TAVR its offer a valuable option for the inoperable or at high risk of surgery patients3..the annual eligible candidate for this procedure expected to be 27,000 in 19 European countries and North America according to recent meta-analysis an...
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..., Welsh R, Feindel C, Lichtenstein S. Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28:520-8.
26-Noble S, Asgar A, Cartier R, Virmani R, Bonan R. Anatomopathological analysis after CoreValve ReValving system implantation.EuroIntervention 2009;5:78–85.
27-Ussia GP, Scarabelli M, Mulè M, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol 2011;108:1772–6.
28- Aspirin Versus Aspirin þ Clopidogrel Following Transcatheter Aortic Valve Implantation: the ARTE trial. 2012. Available at: http://clinicaltrials.gov/ct2/show/nct01559298?term¼nct01559298&rank¼1.Accessed May 30, 2012.
29-Jean-Philippe Collet, Gilles Montalescot, Antithrombotic and antiplatelet therapy in TAVI patients:a fallow field? EuroIntervention 2013;9:S43-S47
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart, and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4).
Nishimura, R. A., & McGoon, M. D. (1999). Editorial: Perspectives on mitral-valve prolapse. The New England Journal of Medicine, 341(1), 48-50. Retrieved from http://search.proquest.com/docview/223939414?accountid=158514
(15)Patel M, Mahaffey K, Garg J, Pan G, Singer D, Hacke W, Breithardt G, Halperin J, Hankey G, Piccini J, Becker R, Nessel C, Paolini J, Berkowitz S, Fox K.. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.. New England Journal Of Medicine. 365 (10), 883-91.
Traditionally, open heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valves. Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays (Types of Heart Surgery. n.d.).
Heart Disease. Those two words often conjure images of an elderly man clutching his chest in a fit of pain and subsequently succumbing to a heart attack. Those two words describe the leading cause of death in Americans--nearly 25%1. Unfortunately, many specific heart problems fade away and fall under the umbrella of only two words. This research paper will discuss one of those heart problems, aortic dissection, in much more detail, than just two little words.
According to Abbott, “Mitral Regurgitation is the most common type of heart valve insufficiency in the United States.” The prefered treatment for mitral regurg is with open heart surgery to replace the insufficient valve. However for many patients, surgery is not an option due to their age, and underlying health conditions. Doctors started to look for a new way to help treat patients with mitral regurg. One that could be performed non invasively, without surgery. Thus the mitraclip was born! To help you,the reader get a better understanding about mitral regurgitation allow me to explain to you what that is. I’ll also explain to you how mitral regurgitation is treated, what a mitraclip is,contraindications for use, potential complications, set up of the mitraclip, and how the mitraclip is deployed.
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
After a thorough examination, J.P. was diagnosed with a deep vein thrombosis (DVT). “DVT develops most often in the legs but can occur also in the upper arms…” (Ignatavicius & Workman, 2013). Due t...
Kaiser, L. R., A. C. O. Surgeons, and W. H. Pearce. Acs surgery, principles & practice. 6th. Webmd Prof Pub, 2007. eBook.
An implantable pacemaker is used to assist the normal contraction rhythm of the heart when the heart’s own generated electrical impulses become impaired which is caused by heart block – delay or no conduction between atria and ventricle.
The purpose the study is the presentation of successful use of Signafuse Bone Graft Putty in vivo. Fusion Products are commonly used in the field of Orthopaedics. They serve an important role as far as relieving pain and treating morbidities.
...., & Jr, L. H. (1992). Release of vasoactive substances during cardiopulmonary bypass. Annals of Thoracic Surgery. doi:10.1016/0003-4975(92)90113-I-6
Per your request, I completed a literature search using UptoDate and GoogleScholar. I performed searches using the terms, drug eluding stents, antiplatelet therapy duration, pci and stents, and antithrombotic therapy. I found some information that may help in answering your question.
Post-operative care includes checking the vital sings every four hours or more frequently as needed and reporting any abnormalities to the physician. Aggressive pain management as mentioned earlier is important in patients who have had a total knee replacement. There an accurate assessment of the patient’s pain level is the initial step in the management of pain in these patients. The patient should be advised to report if the pain goal is not been met. It is important for patients who have had a total knee replacement to ambulate early to prevent the formation of deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore the nurse with the advice of the surgeon and the physical therapy team has to assist the patient to start ambulating soon after the surgery. Also part of the nursing intervention to prevent DVT and PEs includes making sure that the patient is on chemical and mechanical prophylaxis. This will be discussed further in the complications section below. Indwelling Foley catheters are usually placed during a total knee replacement surgery. Part of the nursing intervention will also include making sure that the catheter is removed once it is no longer needed to prevent catheter associated urinary tract infection (CAUTI) (Parker
“Transesophageal scans done in the operating room provide real-time feedback to the surgeon about the health and functioning of the heart and its valves, so that appropriate choice of surgery required may be made at the time of cardiac surgery (hopkinsmedicine.org n.pag.). TEE is most commonly used in open heart surgeries if the patient will allow. It can also be very common in cardiac procedures such as mitral valve repair. During these type of operations, the transesophageal echocardiogram acts as a monitoring tool for the surgeons. It can be used immediately after procedures to make sure everything went as