Personalized treatment strategy for patients with heart defects: the choice between cardiological supervision and surgical intervention
Authors/Creators
- 1. Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow, 117997, Russia.
- 2. Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow, 117997, Russia
- 3. I.M. Sechenov First Moscow Medical University, 2/4 Bolshaya Pirogovskaya str., Moscow, 119991, Russia.
Description
Heart defects are a complex group of diseases that require an individual approach to diagnosis and treatment. This article focuses on developing a personalized management strategy for patients with congenital and acquired heart defects, analyzing the advantages of cardiological follow-up compared to surgical intervention. Modern diagnostic methods, including echocardiography, computed tomography and magnetic resonance angiography, make it possible to assess the severity of the defect, the functional state of the heart and predict the clinical outcome. Based on these data, a decision is made on the need for conservative treatment or surgery.
The work emphasizes the importance of taking into account many factors, such as the patient's age, the degree of damage to the valve apparatus, the presence of concomitant pathology and general health. In some cases, cardiological monitoring may be preferable to control symptoms and monitor the progression of the disease, especially in patients with low surgical tolerance. However, if serious complications develop, such as decompensated heart failure or thromboembolic complications, surgical intervention becomes an urgent solution.
Special attention is paid to modern minimally invasive technologies, such as transcathetic implantation of prosthetic valves and robotic surgical systems, which significantly reduce the risk of complications and accelerate the recovery of patients. The authors also discuss the role of genetic tests and biomarkers in determining the most effective type of therapy for a particular patient.
The authors emphasize the need for a multidisciplinary approach, including the work of cardiologists, surgeons, anesthesiologists, and rehabilitologists, to create an optimal treatment strategy for each patient.
Files
5 Personalized treatment strategy.pdf
Files
(294.0 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:3d449879e16adb55932c913eb098bb0b
|
294.0 kB | Preview Download |
Additional details
References
- 1. Nan, J.; Rezaei, M.; Mazhar, R.; Jaber, F.; Musharavati, F.; Zalnezhad, E.; Chowdhury, M.E.H. Finite Element Analysis of the Mechanism of Traumatic Aortic Rupture (TAR). Comput. Math. Methods Med. 2020, 2020, 6718495.
- 2. Wang, D.D.; Qian, Z.; Vukicevic, M.; Engelhardt, S.; Kheradvar, A.; Zhang, C.; Little, S.H.; Verjans, J.; Comaniciu, D.; O'Neill, W.W.; et al. 3D Printing, Computational Modeling, and Artificial Intelligence for Structural Heart Disease. JACC Cardiovasc. Imaging 2021, 14, 41–60.
- 3. Bhatla, P.; Tretter, J.T.; Chikkabyrappa, S.; Chakravarti, S.; Mosca, R.S. Surgical Planning for a Complex Double-outlet Right Ventricle Using 3D Printing. Echocardiography 2017, 34, 802–804.
- 4. Zivelonghi C, Pesarini G, Scarsini R, Lunardi M, Piccoli A, Ferrero V, Gottin L, Vassanelli C, Ribichini F. Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2017;120:625-31.
- 5. Tarantini G, Dvir D, Tang GHL. Transcatheter aortic valve implantation in degenerated surgical aortic valves. EuroIntervention. 2021;17:709-719.
- 6. Tuncay, V.; van Ooijen, P.M.A. 3D Printing for Heart Valve Disease: A Systematic Review. Eur. Radiol. Exp. 2019, 3, 9.
- 7. Illi, J.; Bernhard, B.; Nguyen, C.; Pilgrim, T.; Praz, F.; Gloeckler, M.; Windecker, S.; Haeberlin, A.; Gräni, C. Translating Imaging Into 3D Printed Cardiovascular Phantoms. JACC Basic. Transl. Sci. 2022, 7, 1050–1062.
- 8. Mensah, G.A.; Roth, G.A.; Fuster, V. The Global Burden of Cardiovascular Diseases and Risk Factors. J. Am. Coll. Cardiol. 2019, 74, 2529–2532.
- 9. Aluru, J.S.; Barsouk, A.; Saginala, K.; Rawla, P.; Barsouk, A. Valvular Heart Disease Epidemiology. Med. Sci. 2022, 10, 32.
- 10. Enriquez-Sarano, M.; Grapsa, J. Valvular Heart Diseases in Women: Facts vs. Incantations. Eur. Heart J. 2023, 44, 833–835.
- 11. Postolache, A.; Sperlongano, S.; Lancellotti, P. TAVI after More Than 20 Years. J. Clin. Med. 2023, 12, 5645.
- 12. Ripley, B.; Kelil, T.; Cheezum, M.K.; Goncalves, A.; Di Carli, M.F.; Rybicki, F.J.; Steigner, M.; Mitsouras, D.; Blankstein, R. 3D Printing Based on Cardiac CT Assists Anatomic Visualization Prior to Transcatheter Aortic Valve Replacement. J. Cardiovasc. Comput. Tomogr. 2016, 10, 28–36.
- 13. Barati, S.; Fatouraee, N.; Nabaei, M.; Petrini, L.; Migliavacca, F.; Luraghi, G.; Matas, J.F.R. Patient-Specific Multi-Scale Design Optimization of Transcatheter Aortic Valve Stents. Comput. Methods Programs Biomed. 2022, 221, 106912.
- 14. Drakopoulou, M.; Oikonomou, G.; Apostolos, A.; Karmpalioti, M.; Simopoulou, C.; Koliastasis, L.; Latsios, G.; Synetos, A.; Benetos, G.; Trantalis, G.; et al. The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial. Life 2023, 13, 1234.
- 15. Haghiashtiani, G.; Qiu, K.; Zhingre Sanchez, J.D.; Fuenning, Z.J.; Nair, P.; Ahlberg, S.E.; Iaizzo, P.A.; McAlpine, M.C. 3D Printed Patient-Specific Aortic Root Models with Internal Sensors for Minimally Invasive Applications. Sci. Adv. 2020, 6, eabb4641.
- 16. Catalano, M.A.; Rutkin, B.; Koss, E.; Maurer, G.; Berg, J.; Hartman, A.; Yu, P.-J. Accuracy of Predicted Effective Orifice Area in Determining Incidence of Patient-Prosthesis Mismatch after Transcatheter Aortic Valve Replacement. J. Card. Surg. 2021, 36, 191–196.
- 17. Thorburn, C.; Abdel-Razek, O.; Fagan, S.; Pearce, N.; Furey, M.; Harris, S.; Bartellas, M.; Adams, C. Three-Dimensional Printing for Assessment of Paravalvular Leak in Transcatheter Aortic Valve Implantation. J. Cardiothorac. Surg. 2020, 15, 211.
- 18. Aigner, P.; Sella Bart, E.; Panfili, S.; Körner, T.; Mach, M.; Andreas, M.; Königshofer, M.; Saitta, S.; Redaelli, A.; Schmid, A.; et al. Quantification of Paravalvular Leaks Associated with TAVI Implants Using 4D MRI in an Aortic Root Phantom Made Possible by the Use of 3D Printing. Front. Cardiovasc. Med. 2023, 10, 1083300.
- 19. Mao, Y.; Ma, Y.; Liu, Y.; Jin, P.; Li, L.; Yang, J. Transcatheter Closure of a Paravalvular Leak After Transcatheter Aortic Valve Replacement with 3-Dimensional Printing Guidance: A Case Report. J. Endovasc. Ther. 2023, 30, 471–476.
- 20. Ninomiya, R.; Orii, M.; Fujiwara, J.; Yoshizawa, M.; Nakajima, Y.; Ishikawa, Y.; Kumagai, A.; Fusazaki, T.; Tashiro, A.; Kin, H.; et al. Sex-Related Differences in Cardiac Remodeling and Reverse Remodeling After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis in a Japanese Population. Int. Heart J. 2020, 61, 961–969.
- 21. Kim WK, Renker M, Doerr O, Hofmann S, Nef H, Choi YH, Hamm CW. Impact of implantation depth on outcomes of new-generation balloon-expandable transcatheter heart valves. Clin Res Cardiol. 2021;110:1983-92.
- 22. Ochiai T, Chakravarty T, Yoon SH, Kaewkes D, Flint N, Patel V, Mahani S, Tiwana R, Sekhon N, Nakamura M, Cheng W, Makkar R. Coronary Access After TAVR. JACC Cardiovasc Interv. 2020;13:693-705.
- 23. Bieliauskas G, Wong I, Bajoras V, Wang X, Kofoed KF, De Backer O, Søndergaard L. Patient-Specific Implantation Technique to Obtain Neo-Commissural Alignment With Self-Expanding Transcatheter Aortic Valves. JACC Cardiovasc Interv. 2021;14:2097-108.
- 24. Yudi MB, Sharma SK, Tang GHL, Kini A. Coronary Angiography and Percutaneous Coronary Intervention After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2018;71:1360-78.
- 25. Zhang, H.; Shen, Y.; Zhang, L.; Song, C.; Jing, Z.; Lu, Q. Preoperative Evaluation of Transcatheter Aortic Valve Replacement with Assistance of 3D Printing Technique: Reanalysis of 4 Death Cases. J. Interv. Med. 2019, 2, 166–170.
- 26. Bharucha, A.H.; Moore, J.; Carnahan, P.; MacCarthy, P.; Monaghan, M.J.; Baghai, M.; Deshpande, R.; Byrne, J.; Dworakowski, R.; Eskandari, M. Three-Dimensional Printing in Modelling Mitral Valve Interventions. Echo Res. Pract. 2023, 10, 12.
- 27. Bertolini, M.; Mullen, M.; Belitsis, G.; Babu, A.; Colombo, G.; Cook, A.; Mullen, A.; Capelli, C. Demonstration of Use of a Novel 3D Printed Simulator for Mitral Valve Transcatheter Edge-to-Edge Repair (TEER). Materials 2022, 15, 4284.
- 28. Okutucu, S.; Mach, M.; Oto, A. Mitral Paravalvular Leak Closure: Transcatheter and Surgical Solutions. Cardiovasc. Revascularization Med. 2020, 21, 422–431.
- 29. Jędrzejek, M. Mitral Paravalvular Leak 3D Printing from 3D-Transesophageal Echocardiography. Anatol. J. Cardiol. 2023, 27, 573–579.
- 30. Vahanian, A.; Beyersdorf, F.; Praz, F.; Milojevic, M.; Baldus, S.; Bauersachs, J.; Capodanno, D.; Conradi, L.; De Bonis, M.; De Paulis, R.; et al. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Eur. Heart J. 2022, 43, 561–632.
- 31. Samaras, A.; Papazoglou, A.S.; Balomenakis, C.; Bekiaridou, A.; Moysidis, D.V.; Patsiou, V.; Orfanidis, A.; Giannakoulas, G.; Kassimis, G.; Fragakis, N.; et al. Residual Leaks Following Percutaneous Left Atrial Appendage Occlusion and Outcomes: A Meta-Analysis. Eur. Heart J. 2024, 45, 214–229.
- 32. Ho, D.R.; Luery, S.E.; Ghosh, R.M.; Maehara, C.K.; Silvestro, E.; Whitehead, K.K.; Sze, R.W.; Hsu, W.; Nguyen, K.-L. Cardiovascular 3-D Printing: Value-Added Assessment Using Time-Driven Activity-Based Costing. J. Am. Coll. Radiol. 2020, 17, 1469–1474.
- 33. Stoller M, Gloekler S, Zbinden R, Tueller D, Eberli F, Windecker S, Wenaweser P, Seiler C. Left ventricular afterload reduction by transcatheter aortic valve implantation in severe aortic stenosis and its prompt effects on comprehensive coronary haemodynamics. EuroIntervention. 2018;14:166-73.
- 34. Faroux L, Guimaraes L, Wintzer-Wehekind J, Junquera L, Ferreira-Neto AN, Del Val D, Muntané-Carol G, Mohammadi S, Paradis JM, Rodés-Cabau J. Coronary Artery Disease and Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74:362-72.
- 35. Kalisz K, Buethe J, Saboo SS, Abbara S, Halliburton S, Rajiah P. Artifacts at Cardiac CT: Physics and Solutions. Radiographics. 2016;36:2064-83.
- 36. Lateef N, Khan MS, Deo SV, Yamani N, Riaz H, Virk HUH, Khan SU, Hedrick DP, Kanaan A, Reed GW, Krishnaswamy A, Puri R, Kapadia SR, Kalra A. Meta-Analysis Comparing Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation With Versus Without Percutaneous Coronary Intervention. Am J Cardiol. 2019;124:1757-64.
- 37. Ochiai T, Yoon SH, Flint N, Sharma R, Chakravarty T, Kaewkes D, Patel V, Nakamura M, Cheng W, Makkar R. Timing and Outcomes of Percutaneous Coronary Intervention in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol. 2020;125:1361-8.