|
Question |
PCI/CABG pre-vascular surgery |
|
Type |
· Multi-centre RCT |
|
Upshot |
· ↔AMI · ↔Mortality |
|
Comments |
· High risk patients excluded (e.g. LMCA disease, LVEF <20%, severe AS) · 98% male |
|
Question |
Metoprolol in patients undergoing non-cardiac surgery |
|
Background |
· Discredited DECREASE studies supported peri-op b-blocker |
|
Type |
· Multi-national RCT |
|
Upshot |
· ↓Non-fatal AMI · ↑Significant bradycardia · ↑Significant hypotension · ↑Stroke · ↑Death |
|
PARTNER B 2010 |
· TAVI > nothing in inoperable patients |
|
PARTER A 2011 |
· TAVI = SAVR in high risk patients |
|
US Corevalve Pivotal Trial 2014 |
· TAVI > SAVR in high risk patients |
|
PARTER 2A 2016 |
· TAVI = SAVR in intermediate risk patients |
|
PARTER 3 2019 |
· TAVI > SAVR in low risk patients at 1 year |
|
Upshot |
· TAVI is for high risk candidates with easy anatomy · Need an MDT to decide · Need cardiac surgeon + perfusionist + gear on-site |
|
Type |
· Multi-national trial |
|
Patients |
· Symptomatic severe AS · Low surgical risk |
|
Pros |
· ↓Stroke (both early and late) · ↓Death · ↓AKI · ↓New AF · ↓Major bleeding |
|
Cons |
· ↑Major vascular complications · ↑Pacemaker requirement (for BBB) · ↑Paravalvular regurgitation · ↑Re-intervention rate · ?↑Mean valve gradient (no P value published) |
|
Caveats |
· Exclusions: poor femoral access, bicuspid valves, difficult anatomy · TAVI patients more likely to develop valve thrombosis (? significance) |
|
Question |
Peri-op aspirin |
|
Type |
· Multi-national, 2x2 factorial placebo-controlled RCT |
|
Subjects |
· Non-cardiac surgery |
|
Upshot |
· ↔Mortality · ↔AMI · ↑Major bleeding in those not already taking aspirin |
|
Question |
Peri-op low dose clonidine |
|
Upshot |
· ↔AMI · ↑Hypotension · ↑Non-fatal cardiac arrest |
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