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Direct oral anticoagulants (DOACs) are getting used off-label with prosthetic heart valves, even mechanical valves in some cases, a national registry showed.
At least some valve patients were discharged with a DOAC prescription at 78.6% 0f the 1,092 hospitals and by 59.6% of the 2,731 physicians participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2014 through June 2017.
For mechanical heart valve recipients, the rate was 1.1% with aortic valve replacement and 1.04% with mitral valve replacement, without significant change over time for either, Ankur Kalra, MD, of the Cleveland Clinic, and colleagues reported in I am really very surprised that DOACs are being used in mechanical heart valves, commented Deepak Bhatt, MD, MPH, of Brigham and Women s Hospital Heart & Vascular Center and Harvard Medical School in Boston, who was not involved with the study.
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Registry data suggested that valve leaflet laceration helped protect patients at risk of coronary artery obstruction during transcatheter aortic valve replacement (TAVR).
Safety of the electrosurgical technique, known as Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA), was reflected in the 3.4% rate of death or disabling stroke at 30 days among 214 patients.
Incidence was 2.8% for mortality, 2.8% for stroke, and 0.5% for disabling stroke, according to Ron Waksman, MD, of MedStar Washington Hospital Center, D.C., and colleagues, reporting in This is comparable to outcomes in patients undergoing TAVR who are not specifically at risk of coronary artery obstruction, the authors noted in their manuscript, presented simultaneously during the virtual Cardiovascular Research Technologies conference on Saturday.
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In experienced hands, the Ross procedure was associated with favorable short- and long-term outcomes in young patients requiring aortic valve replacement (AVR), according to a retrospective cohort study.
Survival was 95.1% at 10 years 88.5% at 15 years among more than 1,400 adults undergoing the double-valve procedure at highly specialized centers, Mostafa Mokhles, MD, PhD, of Utrecht University Medical Center in The Netherlands, and colleagues reported. The Ross procedure continues to be the only living-valve alternative in young and middle-aged patients with a reported survival that compares with the general population well into the second postoperative decade, the group wrote in
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Medicare reimbursement for transcatheter mitral valve repair (TMVR) was extended to include secondary (functional) mitral regurgitation resulting from heart failure, according to a revised National Coverage Determination (NCD).
The Centers for Medicare & Medicaid Services (CMS) renamed the TMVR NCD to cover mitral valve Transcatheter Edge-to-Edge Repair for people with secondary mitral regurgitation who remain symptomatic despite guideline-directed medical therapy.
Notably, registry participation continues to be required as part of the Coverage with Evidence Development (CED) policy.
This comes in response to considerable backlash on a draft proposal to remove the CED requirement in the new NCD. Public commenters also disagreed with the proposed plan to establish coverage for primary (degenerative) mitral regurgitation at the discretion of Medicare Administrative Contractors.