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Flashcards in 2020 Valve General Deck (28)
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1

STS Median Operative Mortality (2019) 

MVr + CABG: 

STS Median Operative Mortality (2019) 

MVr + CABG: 5%

2

Stage A  Valvular heart disease 

Patients At risk:  Patients with risk factors for the development of VHD

 

3

What is considered evidence of significant gastrointestinal dysfunction for the establishment of surgical risk? 

 

gastrointestinal dysfunction

  1. Crohn’s disease
  2. ulcerative colitis
  3. nutritional impairment
  4. serum albumin <3.0

4

What are considered significant neurological organ system dysfunction in the establishment of surgical risk ? 

central nervous system dysfunction

  1. dementia,
  2. Alzheimer’s disease
  3. Parkinson’s disease
  4. a cerebrovascular accident with persistent physical limitation

5

Criteria for LOW surgical risk for Mitral Repair 

All of the below :

STS Risk of Death: < 1% Mortality

Frailty : None

Other Organ System failure Not to be improved post operatively : None

Procedure specific Impediments: None

6

Criteria for Prohibitive Surgical risk

Any of the below :

  • STS Risk of Death: > 50% Mortality or
  • Frailty : >= 2 or
  • Other Organ System failure Not to be improved postoperatively: >= 3 or
  • Severe Procedure specific Impediments.

7

ACC/AHA Guidelines for futility 

STS score >15

Life expectancy <1 y

Poor candidate for rehabilitation

8

Stage B Valvular heart disease

 

B: 

  • Progressive VHD: 
  • Patients with progressive VHD (mild to moderate severity and asymptomatic)

 

9

what organ systems are considered in establishing risk factors for valve surgery?

  1. cardiac dysfunction
  2. kidney dysfunction
  3. pulmonary dysfunction
  4. central nervous system dysfunction
  5. gastrointestinal dysfunction
  6. cancer (active malignancy);
  7. liver dysfunction

10

Utility of TEE 

Provides high-quality assessment of:

mitral and prosthetic valve,

including a definition of intracardiac masses and possible associated abnormalities (eg, intracardiac abscess, LA thrombus)

11

2019 Median operative mortality STS Database for AVR + CABG 

4% 

12

What Patients should Get A/C for atrial fibrillation 

VHD and AF (not rheumatic MS or mech ) 

  • the decision VKA or non-VKA based on 
  • CHA2DS2-VASc score.

Patients with rheumatic mitral stenosis or a mechanical prosthesis and atrial fibrillation

  • should receive oral anticoagulation with a vitamin K antagonist 

13

What are considered significant Renal dysfunction for the establishment of surgical risk? 

kidney dysfunction: 

chronic kidney disease, stage 3 or worse

14

STS Median Operative Mortality (2019) 

AVR + MVR:

STS Median Operative Mortality (2019) 

AVR + MVR: 9%

 

15

What procedures require abx prophylaxis 

Procedures requiring Prophylaxis:

  • Dental procedures that involve:
    1. manipulation of the gingival tissue,
    2. periapical region of the teeth,
    3. perforation of the oral mucosa

 

16

General indications for a mitraclip 

  1. to patients with severely symptomatic primary mitral regurgitation who are at high or prohibitive risk for surgery
  2.  a select subset of patients with secondary mitral regurgitation who remain severely symptomatic despite guideline-directed management and therapy for heart failure.

 

17

2019 Median operative mortality STS Database for AVR 

2.2 %

18

STS Median Operative Mortality (2019) 

MVr:

STS Median Operative Mortality (2019) 

MVr: 1%

 

19

What are considered evidence of significant hepatic dysfunction in the establishment of surgical risk for VHD ? 

  1. history of cirrhosis
  2. variceal bleeding
  3. or elevated INR in the absence of VKA therapy

20

General criteria upon which surgical risk is based 

  1. STS Risk of Death
  2. Frailty
  3. Other Organ System failure Not to be improved postoperatively
  4. Procedure specific Impediments

21

STS Median Operative Mortality (2019) 

MVR+CABG:

STS Median Operative Mortality (2019) 

MVR+CABG: 9%

 

22

what are considered significant Cardiac Risk factors for valve intervention? 

  1. severe LV systolic or diastolic dysfunction
  2. RV dysfunction
  3. fixed pulmonary hypertension

23

STS Median Operative Mortality (2019) 

MVR:

STS Median Operative Mortality (2019) 

MVR: 5%

 

24

 Utility of PET CT 

Aids in the determination of active infection or inflammation

25

Criteria for the establishment of high surgical risk? 

High Surgical risk

Any of the below :

STS Risk of Death: > 8% Mortality or

Frailty : >= 2 or 

Other Organ System failure Not to be improved post operatively : 1-2 or 

Procedure specific Impediments: Possible

26

Criteria for Low Surgical risk for AVR 

ALL of the below :

  • STS Risk of Death: < 3% Mortality
  • Frailty : None
  • Other Organ System failure Not to be improved post operatively : None
  • Procedure specific Impediments: None

27

How many organ system dysfunctions must be present for high surgical risk ? 

Other Organ System failure Not to be improved post operatively : 1-2 

28

 Stage C Valvular Heart  Disease 

C:  Asymptomatic severe Asymptomatic patients who have the criteria for severe VHD:

  • C1: Asymptomatic patients with severe VHD in whom the LV or RV remains compensated.
  • C2: Asymptomatic patients with severe VHD with decompensation of the LV or RV.