Molly Szerlip M.D.

Goldsweig, A. M., H. J. Tak, L. W. Chen, H. D. Aronow, B. Shah, D. Kolte, N. R. Desai, M. Szerlip, P. Velagapudi and J. D. Abbott (2020). “Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy.” Circ Cardiovasc Interv 13(5): e008681.

Full text of this article.

BACKGROUND: The number of patients treated for aortic valve disease in the United States is increasing rapidly. Transcatheter aortic valve replacement (TAVR) is supplanting surgical aortic valve replacement (SAVR) and medical therapy (MT). The economic implications of these trends are unknown. Therefore, we undertook to determine the costs, inpatient days, and number of admissions associated with treating aortic valve disease with SAVR, TAVR, or MT. METHODS: Using the Nationwide Readmissions Database, we identified patients with aortic valve disease admitted 2012 to 2016 for SAVR, TAVR, and disease symptoms (congestive heart failure, unstable angina, non-ST-elevation myocardial infarction, syncope). Patients not undergoing SAVR or TAVR were classified as receiving MT. Beginning with the index admission, we estimated inpatient costs, days, and admissions over 6 months. RESULTS: Among 190 563 patients with aortic valve disease, the average aggregate 6-month inpatient costs were $59 743 for SAVR, $64 395 for TAVR, and $23 460 for MT. Mean index admission was longer for SAVR (10.0 days) than for TAVR (7.0 day) or MT (5.3 days), but the average number of unplanned readmission inpatient days was 2.0 for SAVR, 3.0 for TAVR, and 4.3 for MT; the average number of total admissions was 1.3 for SAVR, 1.5 for TAVR, and 1.7 for MT (P<0.01 for all). TAVR index admission costs decreased over time to become similar to SAVR costs by 2016. CONCLUSIONS: Aggregate costs were higher for TAVR than SAVR and were significantly more expensive than MT alone. However, TAVR costs decreased over time while SAVR and MT costs remained unchanged.

Al-Azizi, K. and M. Szerlip (2020). “Mitral Stenosis After MitraClip: How to Avoid and How to Treat.” Curr Cardiol Rep 22(7): 50.

Full text of this article.

PURPOSE OF REVIEW: The goal of the paper is to highlight the importance of procedural planning and patient selection when using the MitraClip device in treating severe mitral regurgitation (MR). RECENT FINDINGS: Following the recent results of the COAPT trial and FDA approval for functional MR patients, the indications for mitral clip are continuing to expand. Because of this, mitral stenosis from mitral clip can become a problem if the appropriate patients are not selected. Proper valve imaging, utilizing 3D transesophageal echocardiography to identify the pathology, is important to prevent iatrogenic mitral stenosis. In the unfortunate event of severe mitral stenosis as a result of the MitraClip device, surgery is the only treatment.

Shah, P. B., F. G. P. Welt, E. Mahmud, A. Phillips, N. S. Kleiman, M. N. Young, M. Sherwood, W. Batchelor, D. D. Wang, L. Davidson, J. Wyman, S. Kadavath, M. Szerlip, J. Hermiller, D. Fullerton and S. Anwaruddin (2020). “Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID-19) Pandemic: An ACC /SCAI Consensus Statement.” Catheter Cardiovasc Interv Apr 6. [Epub ahead of print].

Full text of this article.

The COVID-19 pandemic has strained health care resources around the world causing many institutions to curtail or stop elective procedures. This has resulted in the inability to care for patients valvular and structural heart disease (SHD) in a timely fashion potentially placing these patients at increased risk for adverse cardiovascular complications including congestive heart failure and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic versus the risk of delaying a needed procedure. In this document, we suggest guidelines as to how to triage patients in need of SHD interventions and provide a framework of how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, we address the triage of patients in need of trans-catheter aortic valve replacement and percutaneous mitral valve repair. We also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic.

Szerlip, M., S. Anwaruddin, H. D. Aronow, M. G. Cohen, M. J. Daniels, P. Dehghani, D. E. Drachman, S. Elmariah, D. N. Feldman, S. Garcia, J. Giri, P. Kaul, N. Kapur, D. J. Kumbhani, P. M. Meraj, B. Morray, K. R. Nayak, S. A. Parikh, R. Sakhuja, J. M. Schussler, A. Seto, B. Shah, R. V. Swaminathan, D. A. Zidar and S. S. Naidu (2020). “Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates.” Catheter Cardiovasc Interv Mar 25. [Epub ahead of print].

Full text of this article.

The COVID-19 pandemic will impact many patients we care for with cardiovascular
disease. The preparedness of healthcare providers is critical in providing the best quality of care with soon to be limited resources, while keeping all personnel as safe as possible. The current key elements include 1) rescheduling of all non-urgent, elective CCL procedures, 2) careful patient selection for urgent and emergent CCL procedures with recognition of potential shifts in risk/benefit ratios in the setting of a highly contagious virus, 3) meticulous donning and doffing of PPE along with cleaning of CCL areas, 4) performance of bedside procedures when possible, and 5) staffing modifications to limit infectivity and preserve staff availability. (Excerpt from text, no abstract available)

Shah, P. B., F. G. P. Welt, E. Mahmud, A. Phillips, N. S. Kleiman, M. N. Young, M. Sherwood, W. Batchelor, D. D. Wang, L. Davidson, J. Wyman, S. Kadavath, M. Szerlip, J. Hermiller, D. Fullerton and S. Anwaruddin (2020). “Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID-19) Pandemic: An ACC /SCAI Consensus Statement.” JACC Cardiovasc Interv Apr 3. pii: S1936-8798(20)30867-0. [Epub ahead of print].

Full text of this article.

The COVID-19 pandemic has strained health care resources around the world causing many institutions to curtail or stop elective procedures. This has resulted in the inability to care for patients valvular and structural heart disease (SHD) in a timely fashion potentially placing these patients at increased risk for adverse cardiovascular complications including congestive heart failure and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic versus the risk of delaying a needed procedure. In this document, we suggest guidelines as to how to triage patients in need of SHD interventions and provide a framework of how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, we address the triage of patients in need of trans-catheter aortic valve replacement and percutaneous mitral valve repair. We also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic