2017 and all that.
The 2017 ESC/EACTS Guidelines for the management of valvular heart disease1 and in particular the recommendations with regard to choice of intervention mode for the treatment of aortic stenosis, may effect more change in cardiology treatment algorithms than most original research published in 2017, marking as they do, a significant shift towards transcatheter aortic valve implantation (TAVI) for intermediate risk patients. It will no doubt take time for this message to be disseminated throughout the cardiology community, however, the paper usefully documents in table form the factors which favour TAVI and those which favour conventional aortic valve replacement surgery. I am hopeful this will help individuals and heart teams develop a more nuanced and patient-centred approach to the management of aortic stenosis. Along similar lines, this issue of Interventional Cardiology Review presents papers that provide updates on specific complications of TAVI and the treatment of specific patient groups. Namely, stroke and cerebral embolism; valve thrombosis; and valve in valve interventions. Mohammed Imran Ghare and Alexandra Lansky provide an excellent review and analysis of the data relating to neurological complications of TAVI. Luca Testa & Azeem Latib, and Neil Ruparelia, respectively, review the diagnosis and treatment of TAVI valve thrombosis. Surgical bioprostheses often have surprisingly small inner diameters with the risk of patient prosthesis mismatch following valve in valve procedures; Adnan Chhatriwalla and colleagues review the novel practice of fracturing surgical aortic valve bioprostheses during such procedures in order to optimise valve areas.
With mitral and tricuspid interventions progress in 2017 has been solid but unspectacular and notable for the low number and relatively high complexity of procedures being undertaken. The Mitralign / Trialign device is one of the leaders in this field and Philipp Lurz and colleagues usefully review its value in the treatment of functional tricuspid regurgitation. Of course, all transcatheter devices are an alternative to surgery and it is important that cardiologists know both the benefits as well as the limitations of the latter. To this end Jorg Kempfert and his team provide a state of the art review of minimally invasive surgical mitral valve repair.
As far as coronary artery intervention is concerned, 2017 will for many be remembered as the year of ORBITA.2 Unlike valvular heart disease, medical treatment is an important part of the management of coronary artery disease, but it is important that the result of ORBITA be viewed objectively: they do not invalidate percutaneous coronary intervention (PCI) as a treatment of stable angina but rather provide a useful reminder of its limitations. At the other end of the spectrum, when compared to coronary artery bypass surgery, incomplete revascularisation has conventionally been regarded as one of the key limitations of PCI; Marco Zimarino and his team critically review the literature relating to this.
Finally, I am pleased to announce that Interventional Cardiology Review is returning to a triannual publication in 2018 with two further issues in May and September.
- Baumgartner H, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease, Euro Heart J 2017;38:2739–86.
Crossref | PubMed
- Al-Lamee R, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet, 2017 Nov 1. pii: S0140-6736(17)32714-9. [Epub ahead of print]
Crossref | PubMed