S. Lockwood

Imaging the left atrial appendage prior to, during, and after occlusion.

PATIENTS WITH ATRIAL FIBRILLATION (AF) HAVE INCREASED RISK for thromboembolic stroke, mainly from a thrombus originating in the left atrial appendage (LAA). Anticoagulation is thus recommended for patients with high risk for stroke but is often underutilized due to issues concerning its risk, need

Imaging Guidance for Transcatheter Aortic Valve Replacement: Is Transoesophageal Echocardiography the Gold Standard?

Transcatheter aortic valve replacement (TAVR) is traditionally performed under cardiac imaging guidance. In the early TAVR experience, intra-procedural transoesophageal echocardiography (TOE) is recommended to guide device deployment, in the context of general anaesthesia (GA). Intra-procedural TOE imaging is particularly useful during TAVR deployment as a contrast-saving strategy for patients with renal impairment. Evidence has emerged recently demonstrating that in selected patients, transthoracic echocardiography (TTE) can be used to provide intra-procedural guidance for TAVR. Additionally, there is a growing body of evidence supporting the performance of TAVR using fluoroscopy alone, without additional cardiac imaging. This article aims to provide a contemporary review of the various procedural imaging approaches for TAVR guidance, comparing the relative strengths and weaknesses of each approach (Table 1).

Role for the left atrial appendage occlusion device in managing thromboembolic risk in atrial fibrillation

Only 50% of patients who would benefit from warfarin therapy for atrial fibrillation (AF) receive treatment because of clinical concerns regarding chronic anti‐coagulation. Percutaneous strategies to treat AF, including pulmonary vein isolation with a curative intent or atrioventricular nodal ablation and implantation of a permanent pacemaker for palliative rate control, have not eliminated the need to manage thromboembolic risk. With the development of a percutaneous left atrial appendage (LAA) occlusion device (the WATCHMAN percutaneous left atrial appendage occluder – Atritech Inc., Plymouth, MN, USA) for thromboembolic protection in non‐valvular AF a significant therapeutic option for select patients may be available. We present the first case performed in Australia (24 November 2009) and explore this new methodology.

The Geometric Interaction Between the LOTUS TAVI Device and the Native Aortic Annulus

Objective: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment to aortic valve replacement (AVR) for selected patients with severe aortic stenosis. A systematic reviewwas conducted to analyse the cost-effectiveness of this novel technique within reimbursed healthcare systems. Methods and results: Two reviewers used seven electronic databases from January 2000 to November 2012 to identify relevant cost-effectiveness studies onTAVI versus AVR or medical therapy. The primary endpoints were the incremental cost-effectiveness ratio (ICER) and the probability of cost-effectiveness. Eligible studies included those in which cost-effectiveness data was measured or projected for TAVI and either medical therapy or AVR. All forms of TAVI were included and all retrieved publications were limited to English language. Eight studies were included for quantitative assessment. The ICER for TAVI compared with medical therapy for surgically inoperable patients ranged between US

Relationship of aortic annular eccentricity and paravalvular regurgitation post transcatheter aortic valve implantation with CoreValve.

26,302 and US

Original InvestigationCatheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study

61,889 per quality adjusted life year gained (PQG). The probability of TAVI being cost-effective compared to medical therapy ranged between 0.03 and 1.00. ICER values for TAVI in comparison to AVR for high-risk surgical candidates ranged between US

TCT-671 Assessment of the Geometric Interaction Between the Lotus Transcatheter Aortic Valve Prosthesis and the Native Aortoventricular Interface by 320-Slice Multidetector Computed Tomography

32,000 and US

Catheter Ablation Versus Medical Rate Control in Heart Failure–an MRI Guided Multicentre Randomised Controlled Trial–the CAMERA-MRI Trial

975,697 PQG. The probability of TAVI being cost-effective in this cohort ranged between 0.116 and 0.709. Conclusions: Based on the accepted Australian ICER threshold of AU

Reduced pulmonary artery pulsatility on dynamic 256-slice CT is associated with severity of emphysema and reduced right ventricular function

69,900 (US

Heart Failure with Reduced LV Ejection Fraction and Atrial Fibrillation/Flutter – What Predicts LV Ejection Fraction Recovery?

71,882) PQG, TAVI is potentially justified on medical and economic grounds in comparison to medical therapy for inoperable patients. However, in the high-risk surgical patient cohort, there is currently insufficient evidence to economically justify the use of TAVI in preference to AVR.