Valve Disease

Question 1

Aortic Stenosis: indications for the surgery in the symptomatic patients

Answer 1

1. High Gradient AS
2. Low flow AS that shows velocity > 4 or transvalvular gradient 40mmHg or AVA < 1.0
3. Normotensive, EF> 50% if stenosis is the likely the cause of symptoms (with acceptable operative risk

Question 2

Aortic stenosis - indications for surgery in asymptomatic patients

Answer 2

1. Severe AS with EF < 50
2. Severe AS undergoing another surgery
3. Severe AS with > 5.0 velocity lows surgicalrisk
4. Rapid progression

Question 3

IB Recs for surgery for AS

Answer 3

• Hi Gradient AS - Severe AS with EF < 50% - Severe AS with velocity > 5.0 - Moderate AS wundergoing annother surgery

Question 4

Recs for surgery for AS if undergoing another cardiac surgery

Answer 4

IB - severe AS undergoing another surgery

IIA- moderate AS (velocity between 3.0-3.9) undergoing another surgery

Question 5

Number of Major Duke criteria for definite diagnosis of Endocarditis

Answer 5

2

Question 6

Number of Duke minor criteria (only) for definite endocarditis

Answer 6

5

Question 7

Number of Duke minor criteria (only) for probable endocarditis

Answer 7

3

Question 8

Number of Duke major and minor criteria for probable endocarditis

Answer 8

1 major and 1 minor

Question 9

Number of Duke major and minor criteria for definite endocarditis

Answer 9

1 major and 3 minor

Question 10

Duke Minor Criteria

Answer 10

1. Predisposing Heart condition
2. IVDA
3. Fever > 100.4
4. Vascular phenomiena - septic embloli, mycotic aneurysm
5. Immunologic pheomena (glomerular nephritis, Osler node, Roth spots, rheumatoid factor
6. • Blood culture not meeting criteria

Question 11

Class I recomendations for surgery for endocarditis

Answer 11

1. Early surgery (before completion of abx) in patients with valve dysfuction leading to heart failure
2. Patients with left sided lesions with highly resistent organisms such as Staph aureus or fungal
3. early surgery with heart block or abscess
4. Recurrent prosthetic valve endocarditis

Question 12

Blood cx organisms meeting major criteria for IE

Answer 12

1. Strep viridans
2. Strep bovis
3. Staph aureus
4. HAECK organism
5. Comiunity acquried enterococci

Question 13

PARTNERS 1 procedural success rate

Answer 13

95%

Question 14

Partners 1 - 30 day mortality rate

Answer 14

3. 4% - Sapien
4. 5% - Surgery (p- 0.07)

Question 15

Partners 1 trial 1 year mortality

Answer 15

24% Sapien

27% Surgery (p - 0.44)

Question 16

Partners trial

stroke - 30 day rate

Answer 16

• Sapien 5.5%
• Surgery 2.4%

(p-0.02)

Question 17

Partners 1 trial stroke 1 year

Answer 17

• Sapien - 8.4%
• Surgery 4.3%

Question 18

Partners 1 Trial

Major vascular complication rate

Answer 18

PARTNERS - Major vascular complication

• Sapien 11%
• Surgery 3%

Question 19

Partners 1 trial major bleeding

Answer 19

• Sapien 9%
• Surgery 19.5%

p - 0.006