Review journal of neurological & medical sciences review.
Perioperative medication optimization and early clinical outcomes following transcatheter aortic valve replacement in severe aortic stenosis: A prospective observational cohort study
By Syed Fozail Sarmad, Javeria Javed, Dr. Asad Ullah and 2 others.
Abstract
Background
Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for patients with high-risk or elderly severe symptomatic aortic stenosis (AS) [1]. However, the complexity of the patients' multi-morbidities and their extensive therapy poses an enormous challenge for peri-interventional pharmacotherapy [16]. This prospective observational cohort study aimed to investigate the prevalence of relevant peri-interventional medication discrepancies and their impact on 30-day outcomes following TAVR in tertiary care cardiovascular hospitals in Rawalpindi, Pakistan [17].
Methods
We prospectively enrolled 120 consecutive adult patients undergoing elective TAVR. Comprehensive standardized multi-disciplinary medication reconciliation was performed at four perioperative milestones: admission, pre-procedure, discharge and 30-day follow up [16]. Patients were divided into two groups based on the presence of any periprocedural medication optimization: those with at least one clinically significant medication discrepancy or non-indication based treatment departure vs those receiving fully optimized pharmacotherapy. The primary endpoint was a 30-day composite clinical endpoint including clinically relevant bleeding (Valve Academic Research Consortium-3 [VARC-3] criteria) [5], acute kidney injury (AKIN/KDIGO criteria) [14], stroke/transient ischemic attack (TIA), symptomatic hypotension requiring vasopressor/inotropic support, unplanned 30-day cardiac readmissions [15] and all-cause mortality.