The Resource Percutaneous heart valve replacement, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by Duke Evidence-based Practice Center ; investigators, John W. Williams Jr. ... [et al.], (electronic book)

Percutaneous heart valve replacement, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by Duke Evidence-based Practice Center ; investigators, John W. Williams Jr. ... [et al.], (electronic book)

Label
Percutaneous heart valve replacement
Title
Percutaneous heart valve replacement
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by Duke Evidence-based Practice Center ; investigators, John W. Williams Jr. ... [et al.]
Contributor
Subject
Language
  • eng
  • eng
Summary
OBJECTIVES: To describe the types of prosthetic heart valves now in use and in development, summarize clinical studies completed or under way, and discuss factors that may impact clinical outcomes for percutaneous heart valve (PHV) replacement. DATA SOURCES: MEDLINE(r), EMBASE(r), and gray literature sources. REVIEW METHODS: We searched the English-language literature to identify systematic reviews and comparative clinical studies of conventional heart valves and studies of PHVs in adults. We define PHV replacement as the delivery of a prosthetic heart valve via a catheter inserted either through a vein or artery (femoral vein; femoral, subclavian, or axillary arteries; or the ascending aorta) or through the apex of the heart via an incision in the chest wall (transapical approach). RESULTS: We identified numerous mechanical and bioprosthetic heart valves. Six systematic reviews compared various conventional valves; the single high-quality review found better short-term hemodynamic performance but longer operating times with stentless compared to stented bioprosthetic valves. A large primary literature (57 randomized controlled trials [RCTs], 40 observational studies) compares various conventional heart valves. Seven manufacturers of PHVs were identified in 62 fully published case reports or non-comparative case series that studied 856 unique patients. All but 19 of these patients received valves produced by one of two PHV manufacturers. The route of access was via the femoral artery in 580 patients (68 percent). The transapical approach was used in 223 patients (26 percent). The route of access for the remaining 53 patients (6 percent) was via the femoral vein, subclavian artery, axillary artery, or ascending aorta. All but two of the prosthetic valves were implanted in the aortic valve position in patients with symptomatic aortic stenosis at high operative risk. Successful implantation was achieved in 92 percent of patients; 30-day survival was 86 percent. The lack of comparative studies limits the ability to determine which variables associated with PHV replacement are causally related to outcomes. A multicenter RCT comparing PHV to conventional heart valve replacement or medical management is currently underway in the United States. CONCLUSIONS: A large number of heart valve prostheses are in use, but there are limited data to inform the selection of one valve over another. There is sufficient existing primary literature to support systematic reviews or meta-analyses to help inform several important clinical questions pertaining to conventional heart valve replacement. PHV replacement is a rapidly emerging technology that has been proven feasible and is a promising therapeutic option for patients with severe, symptomatic aortic stenosis who have a higher risk of poor outcome with surgical aortic valve replacement. Well-designed observational studies and decision modeling could help inform clinical and health policy in the absence of RCTs
Member of
Cataloging source
DNLM
Government publication
federal national government publication
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
http://library.link/vocab/relatedWorkOrContributorName
  • Williams, John W.
  • United States
  • Duke University Evidence-based Practice Center
  • Effective Health Care Program (U.S.)
Series statement
  • Technical briefs
  • AHRQ publication
Series volume
  • 2
  • 10-EHC056-EF
http://library.link/vocab/subjectName
  • Heart Valve Prosthesis Implantation
  • Treatment Outcome
  • Survival Rate
Label
Percutaneous heart valve replacement, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by Duke Evidence-based Practice Center ; investigators, John W. Williams Jr. ... [et al.], (electronic book)
Instantiates
Publication
Note
  • "Contract No. 290-02-0025."
  • "Effective Health Care Program"--PDF cover
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1554759
Dimensions
unknown
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Specific material designation
remote
Label
Percutaneous heart valve replacement, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; prepared by Duke Evidence-based Practice Center ; investigators, John W. Williams Jr. ... [et al.], (electronic book)
Publication
Note
  • "Contract No. 290-02-0025."
  • "Effective Health Care Program"--PDF cover
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1554759
Dimensions
unknown
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Specific material designation
remote

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