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.
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Wesorick DH, Chopra V. Annals for Hospitalists - 20 September 2016. Ann Intern Med. 2016;165:HO1. doi: 10.7326/AFHO201609200
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Published: Ann Intern Med. 2016;165(6):HO1.
Cardiology, Hospital Medicine, Valvular Heart Disease.
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