Molly Szerlip M.D.

Sannino, A., R. C. Stoler, R. F. Hebeler, Jr., M. Szerlip, M. J. Mack and P. A. Grayburn (2017). “Clinical relevance of baseline tcp in transcatheter aortic valve replacement.” J Invasive Cardiol 29(10): 353-358.

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AIMS: To investigate the influence of baseline thrombocytopenia (TCP) on short-term and long-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: A total of 732 consecutive patients with severe, symptomatic aortic stenosis undergoing TAVR from January 2012 to December 2015 were included. Primary outcomes of interest were the relationship of baseline TCP with 30-day and 1-year all-cause mortality. Secondary outcomes of interest were procedural complications and in-hospital mortality in the same subgroups. The prevalence of TCP (defined as platelet count <150 x 109/L) at baseline was 21.9%, of whom 4.0% had moderate/severe TCP (defined as platelet count <100 x 109/L). Compared to no or mild TCP, moderate/severe TCP at baseline was associated with a significantly higher 30-day mortality (23.3% vs 2.3% and 3.1%, respectively; P<.001) and 1-year mortality (40.0% vs 8.3% and 13.4%, respectively; P<.001). In Cox regression analysis, moderate/severe baseline TCP was an independent predictor of 30-day and 1-year mortality (hazard ratio [HR], 13.18; 95% confidence interval [CI], 4.49-38.64; P<.001 and HR, 5.90; 95% CI, 2.68-13.02; P<.001, respectively). CONCLUSIONS: In conclusion, baseline TCP is a strong predictor of mortality in TAVR patients, possibly identifying a specific subgroup of frail patients; therefore, it should be taken into account when addressing TAVR risk.

Basra, S. and M. Szerlip (2017). “Transcatheter aortic valve replacement and mitraclip to reverse heart failure.” Interv Cardiol Clin 6(3): 373-386.

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Valvular heart diseases such as aortic stenosis and mitral regurgitation are often associated with heart failure, which in turn increases patients’ Surgical Thoracic Society (STS) score. A high STS score means the patient is high risk for surgical aortic valve replacement and mitral valve repair/replacement. Transcatheter aortic valve replacement and percutaneous mitral valve repair offer a minimally invasive alternative for the treatment of valvular heart disease in patients with severe heart failure. We aim to review the current evidence on the safety, efficacy, and outcomes of these devices in patients with severe heart failure.

Szerlip, M. (2016). “Transcatheter aortic valve replacement: Only one of the advantages of being female.” J Am Coll Cardiol 68(25): 2745-2746.

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Female sex has been an independent predictor of worse outcomes after surgical aortic valve replacement (SAVR). Over the past decade, transcatheter aortic valve replacement (TAVR) has become the standard of care for treatment of severe symptomatic aortic stenosis in high-risk and inoperable patients. In contradistinction to the SAVR data, TAVR outcomes data from the initial pivotal randomized trials and sponsor’s post-approval registries have shown a survival benefit for female patients compared with male patients. This benefit occurs despite higher periprocedural vascular and bleeding complication rates in female patients. The exact reasons as to why female sex in TAVR confers a survival benefit compared with male sex, especially when it is diametrically the opposite of SAVR, have yet to be determined 1, 2, 3 and 4.