Publications by authors named "David Hildick-Smith"
Article Synopsis
- A study evaluated the effectiveness of invasive versus conservative treatment strategies in older women with non-ST-elevation acute coronary syndrome (NSTEACS), addressing the lack of representation of this group in clinical trials.
- The analysis included 717 women and found that the invasive strategy showed a lower risk of myocardial infarction (MI) and urgent revascularization compared to the conservative approach, although it didn't significantly reduce overall mortality rates.
- The findings suggest that while invasive treatment is beneficial for reducing MI in older women with NSTEACS, it does not impact the overall risk of death or other severe outcomes after one year.
Aortic stenosis (AS) affects about 12% of people aged ≥75 years. Accumulating evidence on the prognostic importance of cardiac damage in patients with asymptomatic and less than severe AS supports the proposition of advancing aortic valve replacement (AVR) to earlier disease stages. Potential benefits of earlier treatment, including prevention of cardiac damage progression and reduced cardiovascular hospitalizations, need to be balanced against the earlier procedural risk and subsequent lifetime management after AVR.
View Article and Find Full Text PDFObjective: We evaluated the clinical safety and performance of the ultrathin strut biodegradable polymer-coated Supraflex Cruz (Sahajanand Medical TechnologiesLtd., Surat, India) sirolimus-eluting stent (SES) in an all-comer patient population requiring coronary stent implantation.
Study Design: The study was a prospective, observational, multicentre, single-arm registry.
Article Synopsis
- Despite advancements in treatment, ischaemic heart disease remains the top cause of illness and death among women, with many being underdiagnosed and undertreated.
- Women face unique risk factors that increase their cardiovascular risk, necessitating a tailored approach in healthcare that includes both traditional and female-specific considerations.
- The British Cardiovascular Society aims to highlight sex-related differences in CVD management, proposing solutions to improve access to diagnosis and treatment for women and encouraging further research on gender disparities in cardiovascular health.
Background: For patients with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is a less invasive but equally effective treatment option compared with surgical aortic valve replacement (SAVR). In 2019, we reported low rates of TAVI in the UK compared with other countries in western Europe and highlighted profound geographical variation in TAVI care. Here, we provide contemporary data on access to aortic valve replacement by either TAVI or SAVR across clinical commissioning groups in England.
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- Data shows that both ad hoc and planned percutaneous coronary intervention (PCI) for unprotected left main stem (uLMS) procedures have been studied, but outcomes for ad hoc cases were previously unclear.* -
- Analysis of over 8,500 uLMS-PCI procedures revealed that ad hoc interventions resulted in higher rates of complications and adverse events, such as in-hospital death and major cardiac issues, compared to planned interventions.* -
- The findings suggest that ad hoc uLMS-PCI is linked to worse in-hospital outcomes, indicating the need for careful procedural planning in such cases.*
Transcatheter aortic valve implantation (TAVI) with commissural alignment aims to limit the risk of coronary occlusion and maintain good coronary access. However, due to coronary origin eccentricity within the coronary cusp, coronary-commissural overlap (CCO) may still occur. TAVI using coronary alignment, rather than commissural alignment, may further improve coronary access.
View Article and Find Full Text PDFPercutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club.
EuroIntervention
August 2024
The 2023 European Bifurcation Club (EBC) meeting took place in Warsaw in October, and the latest evidence for the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to optimise percutaneous coronary interventions (PCI) on coronary bifurcation lesions (CBLs) was a major focus. The topic generated deep discussions and general appraisal on the potential benefits of IVUS and OCT in PCI procedures. Nevertheless, despite an increasing recognition of IVUS and OCT capabilities and their recognised central role for guidance in complex CBL and left main PCI, it is expected that angiography will continue to be the primary guidance modality for CBL PCI, principally due to educational and economic barriers.
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- The trial tested the ShortCut device, aimed at improving safety and effectiveness before TAVI in patients at risk for coronary artery obstruction.
- In a study with 60 patients, 100% successfully underwent leaflet splitting with minimal procedure time and high safety rates; 98.3% were free from major adverse events like stroke or mortality at discharge.
- The results suggest that using ShortCut for modifying failed bioprosthetic aortic valves is safe and leads to positive outcomes for patients facing coronary obstruction during TAVI.
Background: Transcatheter aortic valve implantation (TAVI) serves a growing range of patients with severe aortic stenosis (AS). TAVI has evolved to a streamlined procedure minimizing length of hospital stay.
Aims: To evaluate the safety and efficacy of an early discharge (ED) strategy after TAVI.
Article Synopsis
- Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) often receive less adequate care, prompting a meta-analysis to compare routine invasive versus conservative treatment strategies based on individual patient data from recent trials.
- The study analyzed data from six randomized controlled trials involving 1,479 older adults, focusing on the impact of treatment type on all-cause mortality and myocardial infarction at one year.
- Results indicated no significant difference in mortality rates between the two treatment groups, but routine invasive management showed a lower risk of myocardial infarction and a greater likelihood of urgent revascularization.
Percutaneous left atrial appendage occlusion aims to reduce the risk of stroke in patients with AF, particularly those who are not good candidates for systemic anticoagulation. The procedure has been studied in large international randomised trials and registries and was approved by the National Institute for Health and Care Excellence in 2014 and by NHS England in 2018. This position statement summarises the evidence for left atrial appendage occlusion and presents the current indications.
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- Dialysis is a serious but rare complication following transcatheter aortic valve replacement, and researchers analyzed the TRITAVI registry to develop a clinical score for assessing this risk.
- They identified various preprocedural factors (like male sex, diabetes, and anemia) and procedural features (like contrast volume and need for transfusion) that contribute to the risk, resulting in two scoring systems (TRITAVIpre and TRITAVIpost) which demonstrated strong predictive power.
- The study confirmed that the need for dialysis significantly increases mortality rates, emphasizing the importance of the developed scores in predicting dialysis risk before the procedure.
Percutaneous left atrial appendage occlusion aims to reduce the risk of stroke in patients with AF, particularly those who are not good candidates for systemic anticoagulation. The procedure has been studied in large international randomised trials and registries and was approved by the National Institute for Health and Care Excellence in 2014 and by NHS England in 2018. This position statement summarises the evidence for left atrial appendage occlusion and presents the current indications.
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- Acute ischemic stroke is a significant risk following transcatheter aortic valve replacement (TAVR), prompting the development of cerebral embolic protection devices (CEPD) to reduce this risk.
- A study compared patients who underwent TAVR without CEPD (CEPD-) to those with CEPD (CEPD+) to assess characteristics and outcomes related to stroke.
- Findings indicated no significant differences in stroke rates, severity, or disability outcomes between the two groups, although the CEPD+ group had notably different types of strokes, suggesting that the efficacy of CEPD in preventing acute ischemic stroke is still questionable.
Background: In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting.
Aims: To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies.
Methods: Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER).
Article Synopsis
- The COVID-19 pandemic led to significant treatment delays for patients needing transcatheter aortic valve replacement (TAVR), with a marked decrease in procedure volumes during the first two waves of the pandemic.
- The study analyzed TAVR case data from 130 centers in 61 countries, finding a 15% drop in cases during the first wave and 7% in the second, particularly affecting regions like Africa, Central-South America, and Asia.
- Factors such as hospital type (private vs public), urban vs rural location, low procedure volumes, a country's socioeconomic status, and stringent public health measures contributed to these reductions, highlighting the need for improved public health policies for future health crises.
Redo Transcatheter Aortic Valve Implantation in the Lotus Mechanically Expanded Transcatheter Heart Valve: Bench-Top Analysis, Clinical Experience, and Procedural Guidance.
Circ Cardiovasc Interv
November 2023
Article Synopsis
Article Synopsis
- The study investigates the effects of mitral valve-in-valve (ViV) procedures on patient outcomes, particularly focusing on device position and asymmetry.
- Researchers analyzed data from 222 patients in the VIVID Registry and found that residual mitral valve stenosis was common, affecting 50% of participants, whereas left ventricular outflow tract (LVOT) obstruction was rare, occurring in 3.2% of cases.
- Key findings included that greater asymmetry of the transcatheter heart valve was linked to higher rates of residual stenosis, while deeper atrial implantation seemed to reduce the likelihood of LVOT obstruction.
Article Synopsis
- Doctors are using a method called right transaxillary access to help patients with heart valve problems, especially those who can't use the usual method.
- This new approach allows them to insert a special heart valve more easily and safely.
- Out of six patients treated with this method, only one had a small issue, which was successfully fixed, making this new method their favorite alternative.
Knowledge in the field of bifurcation lesions and chronic total occlusions (CTOs) has progressively improved over the past 20 years. Therefore, the European Bifurcation Club and the EuroCTO Club have decided to write a joint consensus statement to share general knowledge and practical approaches in this complex field. When percutaneously treating CTOs, bifurcation lesions with relevant side branches (SBs) are found in approximately one-third of cases (35% at the proximal cap, 38% at the distal cap, and 27% within the CTO body).
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