Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Experience backs early heart valve replacement

09.03.2006


Results support guidelines for treatment of aortic regurgitation



Patients with leaky aortic heart valves appear to do better when the valves are replaced before significant symptoms develop, as recommended by the American College of Cardiology/American Heart Association guidelines, according to a new study in the Mar. 7, 2006, issue of the Journal of the American College of Cardiology.

"In short, we found that those patients that were operated on early enough following the specific criteria of the guidelines (that is, also assuring that they were not given a too early operation), survived for a longer time and had better health than those patients who were referred for operation in later stages of the disease," said Pilar Tornos, M.D., from the Hospital Universitari Vall d’Hebron in Barcelona, Spain.


Patients with aortic regurgitation may feel only mild symptoms or no symptoms at all. While some patients never need to have their aortic valves replaced, other patients may already be developing heart failure or other problems by the time their aortic regurgitation symptoms become severe; so the challenge has been to determine the best time to recommend surgery.

Guidelines from the American College of Cardiology and the American Heart Association, as well as recommendations from the European Society of Cardiology and other institutions, describe when surgery may be the best option for patients. This study evaluated the results of following such guidelines in clinical practice.

The researchers analyzed data on a total of 170 patients with chronic severe aortic regurgitation, but who did not have coronary artery disease, when they submitted to aortic valve replacement. Patients were divided in two groups depending on the clinical situation at the time of surgery. Group A were 60 patients who were operated on following guidelines advice of earlier surgery, and group B were 110 patients who were operated on late with regard to guidelines recommendations.

Although many of the patients were operated before current guidelines were published, the clinical practice of the hospital for early surgery was generally similar to the subsequent guidelines.

After an average of 10 years, seven patients (12 percent) from the early surgery group had died compared to 37 deaths (37 percent) in the later surgery group. (p = 0.001) The earliest surgery included the study was done 22 years before the analysis and 16 years before the ACC/AHA guidelines.

Dr. Tornos noted that although it may seem obvious that operating earlier would be better, the risks of surgery and follow-up therapy need to be taken into account.

"While too late means a worse prognosis, too early, that is, operating on patients with a more delayed risk of deterioration, would mean an unnecessary surgical procedure and additional years of anticoagulation therapy, which is in itself somewhat hazardous. So a properly timed waiting period may be needed," she said.

This study was not a randomized controlled trial, but Dr. Tornos says a true clinical trial of aortic regurgitation surgery may not be either practical or ethical.

"Usually, observation in real practice represents a risk of mistakenly attributing a nonexistent effect to a given therapy, or missing a real one, and thus clinical trials are mandatory in many instances of therapeutic research. In our example, the magnitude of the difference in the effects of surgery in the two groups and the statistical adjustment for other factors that might have influenced the results make us very confident of our conclusions. In the present state of our knowledge, we feel that a clinical trial to assess the issue addressed by our study would be unethical, as we are convinced enough of the superiority of the established timing of operation over other options," Dr. Tornos said.

Daniel J. Ullyot, M.D., a consultant and surgeon in Burlingame, California, who was not connected with this study, noted the "happy fact" that the Hospital Universitari Vall d’Hebron in Barcelona selected patients for surgery in a way very similar to the guidelines that were published years later, thus providing lengthy follow-up data.

"The importance of this study is the indirect validation of the guidelines with respect to the recommendation for early surgical intervention for asymptomatic and moderately symptomatic patients with aortic valvular regurgitation," Dr. Ullyot said.

"Ideally guidelines would be based entirely on randomized controlled trials and would fulfill the desirable goal that clinical practice be exclusively evidence-based. This goal is incompletely achieved in most instances, and data such as provided by the Tornos paper in support of the guidelines is welcome and reassuring," he added.

Amy Murphy | EurekAlert!
Further information:
http://www.acc.org

More articles from Health and Medicine:

nachricht 'Exciting' discovery on path to develop new type of vaccine to treat global viruses
18.09.2017 | University of Southampton

nachricht A new approach to high insulin levels
18.09.2017 | Schweizerischer Nationalfonds SNF

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

Im Focus: Silencing bacteria

HZI researchers pave the way for new agents that render hospital pathogens mute

Pathogenic bacteria are becoming resistant to common antibiotics to an ever increasing degree. One of the most difficult germs is Pseudomonas aeruginosa, a...

Im Focus: Artificial Enzymes for Hydrogen Conversion

Scientists from the MPI for Chemical Energy Conversion report in the first issue of the new journal JOULE.

Cell Press has just released the first issue of Joule, a new journal dedicated to sustainable energy research. In this issue James Birrell, Olaf Rüdiger,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

IVAM’s LaserForum visits the Swiss canton of St. Gallen with the topic ultrashort pulse lasers

06.09.2017 | Event News

 
Latest News

Robust and functional – surface finishing by suspension spraying

19.09.2017 | Materials Sciences

The Wadden Sea and the Elbe Studied with Zeppelin, Drones and Research Ships

19.09.2017 | Earth Sciences

Digging sensors out of an efficiency hole

19.09.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>