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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses advanced treatments for heart failure (HF) and severe aortic stenosis (SAS). Patients with advanced HF require special intervention, including left ventricular assist device (LVAD) implantation. Studies of the HeartMate II LVAD reported 79% to 90% rates of survival to transplant, recovery, or ongoing device support at 180 days [John R et al. \u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2011; Starling RC et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011; Pagani FD et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2009; Miller LW et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007] and 58% to 63% 2-year survival [Park SJ et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2012; Slaughter MS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBrian T. Bethea, MD, Tenet Florida Region, Florida, USA, discussed advanced treatments for heart failure (HF) and severe aortic stenosis (SAS). Patients with advanced HF require special intervention, including left ventricular assist device (LVAD) implantation. Studies of the HeartMate II LVAD reported 79% to 90% rates of survival to transplant, recovery, or ongoing device support at 180 days [John R et al. \u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2011; Starling RC et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011; Pagani FD et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2009; Miller LW et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007] and 58% to 63% 2-year survival [Park SJ et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2012; Slaughter MS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Heartware Bridge to Transplant trial reported 82% survival at 2 years, with 34% still on the device, 40% transplanted, and 8% recovered [Strueber M et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ERecent LVAD improvements include decreased size and increased durability. Next-generation LVADs include the HeartMate III, HeartMate X, and HeartMate FILVAS.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESAS is life-threatening, and it progresses rapidly. In the PARTNER trial, 50% of inoperable patients died within 1 year [Leon MB et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2010]. The 2014 Valvular Heart Disease guidelines recommend valve replacement for most patients with SAS promptly after symptom onset [Nishimura RA et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2014]. Surgical aortic valve replacement (SAVR) is recommended for low- to moderate- and high-risk patients; transcatheter aortic valve replacement (TAVR) is recommended for high- and greater-risk patients.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe PARTNER trial evaluated TAVR versus SAVR in high-risk operable SAS patients (cohort A) [Smith CR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011] and TAVR versus standard therapy in inoperable SAS patients (cohort B) [Leon MB et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2010]. At 1 year, all-cause mortality in cohort A was 24.3% versus 26.8% in the TAVR and SAVR arms, respectively (p = .001 for noninferiority). Symptom improvement and hemodynamic performance were similar in both groups. There was no significant difference in stroke rates despite increased periprocedural events after TAVR at 30 days or 1 year; rates of all neurologic events were higher in the TAVR group at 30 days and 1 year (p = .04, both). In cohort B, TAVR versus standard therapy patients had a 25% absolute mortality reduction. Major vascular complications and major bleeding were more significant in the TAVR group at 30 days and 1 year (p \u0026lt; .001, all).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe CoreValve pivotal trial had superior 1-year all-cause mortality with TAVR (14.2%) versus SAVR (19.1%; p = .04) [Popma et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2014]. Several next-generation valve systems are under development.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Bethea stressed the importance of a multidisciplinary approach to the treatment of HF and SAS patients, using a \u201cshared care model\u201d [Dickstein K et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/24\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzow63\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}