2020 Valve General

Question 1

STS Median Operative Mortality (2019)

MVr + CABG:

Answer 1

STS Median Operative Mortality (2019)

MVr + CABG: 5%

Question 2

Stage A Valvular heart disease

Answer 2

Patients At risk: Patients with risk factors for the development of VHD

Question 3

What is considered evidence of significant gastrointestinal dysfunction for the establishment of surgical risk?

Answer 3

gastrointestinal dysfunction

1. Crohn’s disease
2. ulcerative colitis
3. nutritional impairment
4. serum albumin <3.0

Question 4

What are considered significant neurological organ system dysfunction in the establishment of surgical risk ?

Answer 4

central nervous system dysfunction

1. dementia,
2. Alzheimer’s disease
3. Parkinson’s disease
4. a cerebrovascular accident with persistent physical limitation

Question 5

Criteria for LOW surgical risk for Mitral Repair

Answer 5

All of the below :

STS Risk of Death: < 1% Mortality

Frailty : None

Other Organ System failure Not to be improved post operatively : None

Procedure specific Impediments: None

Question 6

Criteria for Prohibitive Surgical risk

Answer 6

Any of the below :

• STS Risk of Death: > 50% Mortality or
• Frailty : >= 2 or
• Other Organ System failure Not to be improved postoperatively: >= 3 or
• Severe Procedure specific Impediments.

Question 7

ACC/AHA Guidelines for futility

Answer 7

STS score >15

Life expectancy <1 y

Poor candidate for rehabilitation

Question 8

Stage B Valvular heart disease

Answer 8

B:

• Progressive VHD:
• Patients with progressive VHD (mild to moderate severity and asymptomatic)

Question 9

what organ systems are considered in establishing risk factors for valve surgery?

Answer 9

1. cardiac dysfunction
2. kidney dysfunction
3. pulmonary dysfunction
4. central nervous system dysfunction
5. gastrointestinal dysfunction
6. cancer (active malignancy);
7. liver dysfunction

Question 10

Utility of TEE

Answer 10

Provides high-quality assessment of:

mitral and prosthetic valve,

including a definition of intracardiac masses and possible associated abnormalities (eg, intracardiac abscess, LA thrombus)

Question 11

2019 Median operative mortality STS Database for AVR + CABG

Answer 11

4%

Question 12

What Patients should Get A/C for atrial fibrillation

Answer 12

VHD and AF (not rheumatic MS or mech )

• the decision VKA or non-VKA based on
• CHA2DS2-VASc score.

Patients with rheumatic mitral stenosis or a mechanical prosthesis and atrial fibrillation

• should receive oral anticoagulation with a vitamin K antagonist

Question 13

What are considered significant Renal dysfunction for the establishment of surgical risk?

Answer 13

kidney dysfunction:

chronic kidney disease, stage 3 or worse

Question 14

STS Median Operative Mortality (2019)

AVR + MVR:

Answer 14

STS Median Operative Mortality (2019)

AVR + MVR: 9%

Question 15

What procedures require abx prophylaxis

Answer 15

Procedures requiring Prophylaxis:

• Dental procedures that involve:
  
  1. manipulation of the gingival tissue,
  2. periapical region of the teeth,
  3. perforation of the oral mucosa

Question 16

General indications for a mitraclip

Answer 16

1. to patients with severely symptomatic primary mitral regurgitation who are at high or prohibitive risk for surgery
2. a select subset of patients with secondary mitral regurgitation who remain severely symptomatic despite guideline-directed management and therapy for heart failure.

Question 17

2019 Median operative mortality STS Database for AVR

Answer 17

2.2 %

Question 18

STS Median Operative Mortality (2019)

MVr:

Answer 18

STS Median Operative Mortality (2019)

MVr: 1%

Question 19

What are considered evidence of significant hepatic dysfunction in the establishment of surgical risk for VHD ?

Answer 19

1. history of cirrhosis
2. variceal bleeding
3. or elevated INR in the absence of VKA therapy

Question 20

General criteria upon which surgical risk is based

Answer 20

1. STS Risk of Death
2. Frailty
3. Other Organ System failure Not to be improved postoperatively
4. Procedure specific Impediments

Question 21

STS Median Operative Mortality (2019)

MVR+CABG:

Answer 21

STS Median Operative Mortality (2019)

MVR+CABG: 9%

Question 22

what are considered significant Cardiac Risk factors for valve intervention?

Answer 22

1. severe LV systolic or diastolic dysfunction
2. RV dysfunction
3. fixed pulmonary hypertension

Question 23

STS Median Operative Mortality (2019)

MVR:

Answer 23

STS Median Operative Mortality (2019)

MVR: 5%

Question 24

Utility of PET CT

Answer 24

Aids in the determination of active infection or inflammation

Question 25

Criteria for the establishment of high surgical risk?

Answer 25

High Surgical risk **Any of the below :** STS Risk of Death: \> 8% Mortality or Frailty : \>= 2 or Other Organ System failure Not to be improved post operatively : 1-2 or Procedure specific Impediments: Possible

Question 26

Criteria for Low Surgical risk for AVR

Answer 26

**ALL** of the below : * STS Risk of Death: \< 3% Mortality * Frailty : None * Other Organ System failure Not to be improved post operatively : None * Procedure specific Impediments: None

Question 27

How many organ system dysfunctions must be present for high surgical risk ?

Answer 27

Other Organ System failure Not to be improved post operatively : 1-2

Question 28

Stage C Valvular Heart Disease

Answer 28

**C:** Asymptomatic severe Asymptomatic patients who have the criteria for severe VHD: * **C1:** Asymptomatic patients with severe VHD in whom the LV or RV remains compensated. * **C2:** Asymptomatic patients with severe VHD with decompensation of the LV or RV.