David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Although originally studied only in patients with prohibitive surgical risk, there is now evidence that TAVI results in early and midterm mortality rates that are at least as good as SAVR, even in some patients with low or intermediate surgical risk.
More data are needed to understand longer-term outcomes, because the durability of the TAVI prosthesis is uncertain. However, with increased experience, technological improvements, and availability of longer-term data, TAVI may begin to play a larger role in the treatment of patients with aortic stenosis.
TAVI and SAVR are associated with different complications. The incidence of periprocedural myocardial infarction, major bleeding, acute kidney injury, and new-onset atrial fibrillation is higher with SAVR, but pacemaker implantation, vascular complications, and paravalvular leak occur more commonly with TAVI.
Familial clustering suggests that genetic factors influence risk for SAB.
The magnitude of the increased risk for patients with first-degree relatives with SAB is small compared with that of other known risk factors (e.g., HIV, diabetes, cancer, intravenous drug use, and catheter placement).
Although the immediate clinical implications of this finding are unclear, genetic factors placing hosts at increased risk for infection are of growing interest and may play a role in diagnosis, evaluation, and treatment of common clinical conditions.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Wesorick DH, Chopra V. Annals for Hospitalists - 20 September 2016. Ann Intern Med. ;165:HO1. doi: 10.7326/AFHO201609200
Download citation file:
Published: Ann Intern Med. 2016;165(6):HO1.
Cardiology, Hospital Medicine, Valvular Heart Disease.
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use