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Largest U.S. Cardiac Database Shows Excellent Long-term Survival After Surgical Aortic Valve Replacement

Study in Low-Risk Patients Reveals 5-year Survival Rate of 93%

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Newswise — A study published today in The Annals of Thoracic Surgery demonstrates outstanding long-term survival following low-risk isolated surgical aortic valve replacement (SAVR).

The study reviewed 42,586 patients who underwent low-risk isolated SAVR between 2011 and 2019 at 981 different cardiac surgery programs across the U.S. Conducted by eight leading national investigators, the assessment relied on evidence from The Society of Thoracic Surgeons (STS) National Database, with linkage to the Centers for Disease Control and Prevention’s National Death Index (NDI).

The STS National Database, with nearly 10 million patient records, is the nation’s largest and most comprehensive clinical registry for cardiothoracic disease. The linkage to the NDI has permitted highly accurate survival information to now be available following heart and lung operations performed in the U.S.

All patients in the study were classified as low risk for SAVR mortality as defined by the STS predicted risk of operative mortality (PROM ≤ 4%). Overall, 92.9% survived after five years, and the eight-year survival was close to 90%. The study matched the criterion used in the current low-risk trials evaluating SAVR with transcatheter aortic valve replacement (TAVR). The average age of patients was 74.2 years with a mean PROM of 1.92%

“This study sets a benchmark for outcomes for management of aortic valve stenosis,” said Vinod Thourani, MD, Bernie Marcus Chair of Cardiovascular Surgery and the Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia. “This analysis is significant because of the longitudinal follow-up with very large numbers of patients, and it is an important complement to results from randomized clinical trials that are commonly measured over just one year.”

Recent evidence has revealed that SAVR following failed TAVR requiring explant of the TAVR valve, has been the fastest-growing cardiac procedure over the last five years, associated with worse outcomes than those expected following primary SAVR surgeries.

The most recent mid-term results from the PARTNER 3 and Evolut Low-Risk trials comparing risk of death and stroke from SAVR and TAVR are expected to be released in fall 2023. As there have been some concerns raised regarding the representativeness of these trials, the current study was performed to establish real-world long-term results from SAVR to serve as a benchmark for outcomes.

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“There remains absolutely no doubt that TAVR is an excellent primary option for patients of higher risk or advanced age. The aim of this study was to specifically evaluate patients of low risk, and this revealed that longitudinal outcomes of SAVR in this specific population are outstanding. As surgeons are consistently performing these surgeries with excellent outcomes, and now in minimally invasive fashion, these data should give providers of valve therapy, including cardiologists and surgeons, a point of reflection when it comes to deciding what the best option is for their patients,” said senior study author Vinay Badhwar, MD, Professor and Chairman of the Department of Cardiovascular and Thoracic Surgery of West Virginia University, and Executive Chair of the WVU Heart and Vascular Institute.

The STS National Database includes 97% of all cardiac operations performed in the U.S. with precise and validated statistical models for patients receiving adult cardiac, general thoracic, and congenital operations.

Study authors also included Robert H. Habib, PhD, Wilson Szeto, MD, Joseph Sabik, MD, Jennifer Romano, MD, MS, and Thomas MacGillivray, MD.

Link to “Survival Following Surgical Aortic Valve Replacement in Low-Risk Patients: A Contemporary Trial Benchmark:” https://www.annalsthoracicsurgery.org/article/S0003-4975(23)01064-0/fulltext

Journal Link: The Annals of Thoracic Surgery, Oct-2023

Source: The Society of Thoracic Surgeons

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Know These 4 Core Factors to Avoid a Heart Health Syndrome

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(Family Features) In the U.S., 1 in 3 adults is at risk for a newly recognized syndrome that comes from a combination of heart disease, kidney disease, type 2 diabetes and excess body weight. This cluster of conditions, called cardiovascular-kidney-metabolic (CKM) syndrome, is an example of how problems in one part of your body can affect other parts.

To avoid CKM syndrome, health experts suggest paying close attention to four of the American Heart Association’s Life’s Essential 8 – blood pressure, lipids, body weight and blood sugar level – which are core health factors that impact your metabolic health.

Good metabolic health means your body uses energy well and keeps these factors in a normal range. However, when numbers are off in one area, it can affect others, raising your risk for heart disease, stroke, kidney disease and diabetes.

Consider these tips from the American Heart Association to help keep your core health factors under control.

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Blood Pressure
High blood pressure, also known as hypertension, happens when the force of your blood pushing against the walls of your blood vessels is too high. High blood pressure is a leading cause of heart disease, stroke and kidney disease.

Because high blood pressure doesn’t have symptoms, the only way to know you have it is to get your blood pressure checked. Healthy blood pressure is below 120/80. If your blood pressure is 130/80 or higher, talk to your doctor about checking your other core health factors.

Lifestyle changes can help reduce high blood pressure. One example is a Dietary Approaches to Stop Hypertension (DASH) eating pattern that’s low in fat and rich in fruits, vegetables, whole grains and low-fat dairy products. Losing 10 pounds and reducing alcohol consumption can also reduce blood pressure.

Cholesterol
Cholesterol is a waxy substance your liver makes then circulates in the blood where your body uses it to build cells and make vitamins and hormones. You may also get cholesterol from eating animal products. If there’s too much cholesterol circulating, your risk of type 2 diabetes, heart disease and stroke may increase.

For optimal CKM health, your LDL cholesterol should be below 100 and triglycerides below 150. Triglycerides are the most common type of fat in the body. If your triglyceride level is 135 or higher, talk to your doctor about decreasing your risk.

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Losing body weight and increasing physical activity decrease triglyceride levels. In addition, DASH and Mediterranean (plant-based, high-fiber, low-fat) eating patterns support healthy LDL and triglyceride levels.

Body Weight
Healthy weight may be determined by body mass index (BMI), a number that represents your weight in relation to your height. Extra body fat can mean a higher risk for many health problems, including heart disease, stroke, high blood pressure, high cholesterol and diabetes.

CKM syndrome starts when BMI is 25 or higher and waist circumference is 88 centimeters or higher for women and 102 centimeters or higher for men. Aim for a BMI between 18.5-25.

To lose weight and keep it off, start by setting realistic goals. Understand how much and why you eat, manage portion sizes, make smart snack substitutions and be physically active.

Blood Sugar
High blood sugar can slowly damage the kidneys. In fact, diabetes is the leading cause of kidney disease, and it increases the risk of heart attack and stroke.

Blood sugar is measured in two ways: a fasting blood glucose test (short term blood sugar) and an A1C test (long term blood sugar control). A normal fasting blood glucose level is 70-99 and a normal A1C level is below 5.7%. Fasting blood glucose above 125 and A1C of 6.5% or higher means you have diabetes.

Habits that help you avoid high blood pressure, weight gain and high cholesterol also keep your blood sugar in check. These are especially important if you have a family history of diabetes.

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Learn more about CKM syndrome and how to manage your risk at heart.org/CKMhealth.

Photos courtesy of Shutterstock

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SOURCE:
American Heart Association


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Lifestyle

Expert Pregnancy Tips for Staying Healthy This Winter

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(Family Features) Staying up to date on recommended vaccines is important during pregnancy. This is especially true during the winter months when more people tend to get sick from flu, COVID-19 and RSV. These viruses can be especially dangerous for pregnant people and babies.

Vaccines are an important part of routine pregnancy care, both for you and your baby. Getting vaccinated against flu and COVID-19 can cut your risk of hospitalization by about half.

Now is the time to get vaccinated if you haven’t already. Flu vaccines help protect you from getting the flu and getting seriously ill, so it’s a good idea to schedule an appointment now. The latest COVID-19 vaccines are important too because they lower your risk of serious illness. An RSV vaccine may also be recommended for when you are 32-36 weeks pregnant. Be sure to talk to your doctor.

“Right now, we are seeing a concerning increase in cases of respiratory diseases, such as the flu, COVID-19 and RSV,” said Adm. Rachel Levin, MD, assistant secretary for health at the U.S. Department of Health and Human Services. “I encourage all pregnant people to take preventive action to protect their health and the health of their baby. The best and safest way to do this is to get vaccinated. Getting vaccinated is easy and is usually covered by insurance.”

Help Protect Your Baby 
When you get flu, COVID-19 and RSV vaccines, you’re helping protect your baby by passing your immunity on to them. Getting vaccinated against flu, COVID-19 and RSV during pregnancy can protect your baby during the first 6 months of life. These viruses can be very harmful to newborns. In fact, RSV is the leading cause of hospitalization in infants

Talk to Your Doctor About Timing
Millions of people in the U.S. have already gotten vaccinated against flu, COVID-19 and RSV this season. If you haven’t gotten your vaccines yet, be sure to talk with your doctor. They can help you choose the right vaccines and determine the best timing to help protect you and your baby.

Get the Facts
Getting vaccinated can give you peace of mind, ensuring you have done everything you can to protect yourself and your baby from serious respiratory illness. Information can give you power and comfort, especially when you’re pregnant.

Go to cdc.gov/RiskLessDoMore to learn more about flu, COVID-19 and RSV vaccines, or go to vaccines.gov to get started today.

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SOURCE:
U.S. Department of Health and Human Services


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Here’s to a Healthy New Year: What your family needs to know about vaccines

Vaccines for flu, COVID-19, and RSV are vital for family health, especially as respiratory viruses increase during colder months. Stay updated to reduce serious illness and hospitalizations.

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(Family Features) This year, make a plan to keep your family healthy by helping them get vaccinated for respiratory infections like flu, COVID-19 and RSV. These respiratory illnesses are more likely to become serious for people who are not up to date on their vaccines.

In colder months, respiratory viruses tend to surge, and people spend more time indoors where they are more likely to be exposed. These respiratory infections can cause serious illness and hospitalization. This season’s flu and COVID-19 vaccines, as well as the RSV vaccine, are the best way to help your family risk less serious illness and do more of what they enjoy.

What should your family know?
Vaccines can keep you and your family from getting very sick from respiratory illnesses. The Centers for Disease Control and Prevention (CDC) recommends everyone ages 6 months and older get this season’s flu and COVID-19 vaccines.

In addition, all adults ages 75 and older – and those ages 60 and older with certain health conditions or who live in a nursing home – should get one dose of an RSV vaccine if they haven’t before. Pregnant people should also talk to their doctor about getting an RSV vaccine to protect their baby during their first 6 months of life.

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Is your family at high risk?

It’s important to know the risks of getting very sick from flu, COVID-19 or RSV. According to the CDC, some people have a higher risk than others, including:

  • People not up to date on their vaccines: Vaccines cut your risk of needing hospital care for flu or COVID-19 by about half, according to the CDC. In 2023, 90% of adults admitted to the hospital for COVID-19 were not up to date on their COVID-19 vaccine. People who skipped their flu shot were twice as likely to need to see a doctor for the flu.
  • Older adults: Most flu, COVID-19 and RSV deaths are in people ages 65 and older. If you help care for an older family member or friend, let them know vaccines are their best protection from getting very sick.
  • People with underlying health conditions: Heart and lung disease, diabetes, kidney disease and other chronic conditions can cause complications and more severe illness from flu, COVID-19 and RSV.
  • Those who live in long-term care: Respiratory viruses can be a greater threat to older people in long-term care, who often have health issues that raise their risk of severe flu, COVID-19 or RSV.
  • Pregnant people: Pregnancy raises the risk of severe illness from flu and COVID-19. Getting vaccinated during pregnancy helps protects the pregnant person and baby. An RSV vaccine during pregnancy protects the baby from severe RSV in their first 6 months of life.

Get your family vaccinated now for a healthy new year
Join the millions of people who’ve already gotten vaccinated this season. Take your family to get vaccinated now to risk less severe illness and do more of what you enjoy. It’s safe to get flu and COVID-19 vaccines (and an RSV vaccine, if eligible) at the same time.

Visit cdc.gov/RiskLessDoMore to learn more about flu, COVID-19 and RSV vaccines. Talk with your doctor about which vaccines are right for you or go to vaccines.gov to find a nearby pharmacy. You can order free COVID-19 test kits (up to four per household) at COVIDTests.gov

Know Your Risk 
In the United States, there are additional groups of people who are at higher risk from these respiratory illnesses.

  • People in rural parts of the country: Vaccines matter even more in rural areas where there may be fewer doctors or clinics to help people who get very sick. Yet in these regions, less than half of adults got a flu vaccine last year. Fewer than 1 in 5 got an updated COVID-19 vaccine.
  • Black and Hispanic people: At last year’s respiratory virus peak, Black people were more likely than white and Hispanic people to be in the hospital for flu, COVID-19 or RSV. By the end of last year’s virus season, Hispanic people were more likely than non-Hispanic white people to have been in the hospital for flu.

Photos courtesy of Shutterstock

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SOURCE:
U.S. Department of Health and Human Services


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