{"id":13609,"date":"2011-11-14T10:22:13","date_gmt":"2011-11-14T15:22:13","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=fellowship-training&p=13609"},"modified":"2011-11-14T12:29:31","modified_gmt":"2011-11-14T17:29:31","slug":"stenosis-vs-stroke-is-treatment-worth-the-risk","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/11\/14\/stenosis-vs-stroke-is-treatment-worth-the-risk\/","title":{"rendered":"Stenosis vs. Stroke: Is Treatment Worth the Risk?"},"content":{"rendered":"

Several Cardiology Fellows who are attending AHA.11 this week are blogging together on CardioExchange.\u00a0 The Fellows include\u00a0Revathi Balakrishnan<\/a>,<\/a> Eiman Jahangir<\/a>, John Ryan<\/a> (moderator), and Amit Sha<\/a>h. Read the previous post here<\/a>. Check back often to learn about the biggest buzz in Orlando.<\/em><\/p>\n

On Sunday morning, I feel like the conference has really begun. I am sitting in the Chaplin Theater, a very large auditorium that is about half full of people. They\u2019re waiting to hear various presentations and discussions during the \u201cGroundbreaking Studies in the Cardiovascular Medicine: Circulation Editor\u2019s Choice,\u201d \u00a0a 3-hour session full of presentations and discussions on topics from dabigatran to transcatheter aortic heart valve implantation (TAVI) to racial and ethical differences in the treatment of AMI.<\/p>\n

The TAVI discussion really drew my interest. As a future interventional cardiologist, I believe that treating structural heart disease and using procedures such as TAVI are going to be a large portion of my practice over the next decade. Presenters discussed recent results from the PARTNER B trial<\/a> that evaluated the use of TAVI in old and fragile patients who were unable to obtain surgery and who had many comorbidities. TAVI showed superior 2-year all-cause mortality compared with conventional surgery (approximately 18% vs. 35%) as well as similarly improved rate of repeat hospitalizations. Despite these benefits, patients in the TAVI arm did have increased stroke risk compared to surgery. These results are both exciting and concerning. While aortic stenosis causes severe comorbidity and mortality, the risk of stroke may be too high for some individuals (over 13% in the TAVI arm).<\/p>\n

As a physician, nothing scares me more than causing harm to a patient, especially in the form of stroke. I know this harm well because my grandfather had a devastating stroke in the early 1990s after a CABG. Since his stroke, my grandfather has had aphasia and hemiparalysis. He went from a professor of pharmacology to being dependent on others for his care. \u00a0Stroke is a known and low risk of many procedures, but its impact is severe both to patients and to their families.<\/p>\n

Do you think that a 13% risk for stroke is too high for the treatment of aortic stenosis?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Several Cardiology Fellows who are attending AHA.11 this week are blogging together on CardioExchange.\u00a0 The Fellows include\u00a0Revathi Balakrishnan, Eiman Jahangir, John Ryan (moderator), and Amit Shah. Read the previous post here. Check back often to learn about the biggest buzz in Orlando. On Sunday morning, I feel like the conference has really begun. I am […]<\/p>\n","protected":false},"author":493,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[476,195,396,423],"class_list":["post-13609","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-aha","tag-fellowship-training-2","tag-partner","tag-tavi"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/13609","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/493"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=13609"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/13609\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=13609"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=13609"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=13609"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}