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TAVR Discharge Timing; Stentreiver Anesthesia; New Valve Depression

TAVR Discharge Timing; Stentreiver Anesthesia; New Valve Depression

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Next-day discharge after transfemoral transcatheter aortic valve replacement (TAVR) appeared safe for patients without initial complications in a single-center observational study of consecutive patients, reported in JACC: Cardiovascular Interventions.

The 30-day combined mortality and readmission rate did not differ significantly for patients who stayed 1 night versus longer. At 1 year, next-day discharge actually held a significant advantage over longer stays (15.2% versus 30.8%, adjusted HR 0.47), driven by noncardiovascular-related readmissions.

However, an accompanying editorial cautioned that the fact that noncardiovascular admissions drove superiority at 1 year “merely reemphasizes that the next-day discharge patients in this study were lower risk rather than that they benefited by next-day discharge.”

See MedPage Today‘s full coverage here.

Anesthesia in Stroke Thrombectomy

For endovascular treatment of acute ischemic stroke, patients were no worse, and potentially better off, with general anesthesia than with conscious sedation, according to the single-center, open-label, randomized GOLIATH trial.

MRI before and 48 to 72 hours after thrombectomy showed no significant difference in the primary endpoint of growth in infarct size. But secondary outcomes of final infarct volume, successful reperfusion rate, and favorable functional outcome at 90 days all significantly favored general anesthesia.

However, the researchers wrote online in JAMA Neurology that their trial might have been underpowered for even the primary endpoint. Numerous nonrandomized studies that have reported better outcomes with conscious sedation and no reperfusion or functional outcome advantages were seen with general anesthesia in the AnStroke trial, they added.

MedPage Today has the rest of the story here.

Depression with a New Valve

Seniors who screen positive for depression after TAVR or surgical aortic valve replacement (SAVR) were 2.2 fold more likely to die from any cause in the first month and 53% more likely to die in the first 12 months after the procedure than those without depressive symptoms.

The analysis of the Frailty Aortic Valve Replacement prospective cohort study also found that the association held strong for both TAVR and SAVR. Depression persisting to 6 months post-procedure was linked to a nearly threefold risk of mortality at 12 months.

“The clinical implications of our findings support active screening for depression before and after aortic valve procedures to identify patients who may benefit from further psychiatric evaluation for the diagnosis and treatment of a depressive disorder,” the authors wrote online in JAMA Cardiology. “This two-tiered approach is in line with the American Heart Association recommendation to screen for depression with a brief questionnaire and, when the finding is positive, to confirm the diagnosis with a comprehensive expert evaluation.”

MedPage Today has the full story here.

Ruptured Brain Aneurysm Prognostication

A clinical prediction model for mortality after ruptured intracranial aneurysm had good accuracy for predicting mortality and functional outcome at 3 months, researchers reported in BMJ.

The model, which included age, pre-existing hypertension, neurological grade on admission, clot volume, aneurysm size, and location, had an area under the receiver operator characteristics curve of 0.81 for functional outcome and 0.76 for mortality risk.

The online prognostic calculator and smartphone app “could be adjunctive tools to support management of patients” based on items readily derived at admission, the researchers concluded.

In Other News

Prior authorization paperwork requirements are three to 11 times greater for PCSK9 inhibitors than for other cardiometabolic drugs, according to an analysis of insurance plans covering more than 95% of insured Americans, reported in Circulation: Cardiovascular Quality and Outcomes.

2018-01-19T12:00:00-0500

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