A Heart Team Approach to ACC.19: Surgeon's Perspectives on Major ACC.19 Trials

The ACC.19 Scientific Session provided a plethora of long-awaited medical and technological advances with significant impact in cardiovascular medicine. Over the past several years, with the growth of transcatheter interventions, the breadth of research presented at ACC.19 has grown to include landmark trials with relevance to both surgeons and cardiologists who work collaboratively within a heart team model. Whether this collaboration is focused on the management of aortic stenosis, mitral regurgitation, heart failure or aortic pathologies, there is a clear benefit to patients when management decisions utilize a collaborative, multidisciplinary approach. In the spirit of this collaboration, members of the ACC Surgeon's Council have carefully selected some of the most noteworthy presentations from ACC.19 with relevance to both surgeons and cardiologists and provide perspectives on the research findings. Five articles, written by Surgeon's Council members who are leaders in their respective fields, are highlighted below. These articles provide unique perspectives on timely topics that will continue to rely on collaboration across specialties for success and growth.

  1. "Low-Risk TAVR Trials: Will TAVR Replace SAVR for Aortic Stenosis" by Drs. Eldelman, Shults and Thourani at Medstar Heart and Vascular Institute and Georgetown University, Washington, DC. One of the most highly anticipated series of late-breaking trials from ACC.19 were the balloon- and self-expandable trials of TAVR versus SAVR in low-risk patients with aortic stenosis. This article provides a summary of the major trial findings as well as perspectives on the role of surgery in the modern management of aortic stenosis.
  2. "TAVR for Bicuspid Aortic Valves: Is Surgery Still the Gold Standard?" by Drs. Malasarie and McCarthy at Northwestern Medical Center, Chicago, IL. TAVR randomized trials have traditionally excluded patients with bicuspid aortic valve disease. At ACC.19, an expansive registry study with outcomes of over 2,726 patients with bicuspid aortic valves who underwent TAVR was presented. The authors summarize the major findings and provide perspective on areas of future research and which patients with bicuspid valves may benefit best from surgery.
  3. "Assessing Efficacy of the MitraClip: Echocardiographic Outcomes" by Dr. Ramakrishna from the Mayo Clinic, Rochester, MN. The COAPT trial has provided a strong evidence base for the use of MitraClip in patients with secondary mitral regurgitation. This article highlights an extensive COAPT sub-study examining echocardiographic variables associated with MitraClip success.
  4. "Will Heartmate 3 Left Ventricular Assist Device Gain Momentum With New Study Results?" by Drs. Hanna and Firstenberg from the Medical Center of Aurora, Aurora, CO. Left ventricular assist devices (LVADs) have undergone dramatic technical innovation. The MOMENTUM 3 trial highlighted the results of the HeartMate3 compared to the HeartMate2 for the treatment of advanced heart failure. The authors provide perspective on the major findings from MOMENTUM 3 and the role of LVADS in the modern surgical management of end-stage heart failure.
  5. "International Outcomes With Acute Aortic Dissection: Progress and Opportunity" by Dr. Alexander Iribarne, Dartmouth-Hitchcock Medical Center, Lebanon, NH. For the past 25 years, the International Registry of Acute Aortic Dissection (IRAD) has served as a robust collaboration dedicated to improving outcomes with aortic dissection. At ACC.19 IRAD data on 9,000 patients showed improvements in in-hospital survival for both type A and B aortic dissection but important targets for future quality improvement in diagnosis and management. The article provides a summary of the IRAD findings and discusses future areas of needed research in aortic dissection.

Keywords: Acute Coronary Syndrome, Acute Kidney Injury, Aneurysm, Dissecting, Aortic Aneurysm, Aorta, Aortic Valve Insufficiency, Aortic Valve, Aortic Valve Stenosis, Arrhythmias, Cardiac, Arterial Pressure, Atherosclerosis, Atrial Appendage, Atrial Fibrillation, Bicuspid, Biomarkers, Cardiac Surgical Procedures, Constriction, Pathologic, Constriction, Pathologic, Conversion to Open Surgery, Coronary Artery Bypass, Coronary Disease, Creatinine, Diagnosis, Differential, Disease-Free Survival, Dilatation, Echocardiography, Endovascular Procedures, Factor VII, Follow-Up Studies, Heart Defects, Congenital, Heart Transplantation, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Heart-Assist Devices, Hemodynamics, Hemorrhage, Hospital Mortality, Hospitalization, Hypertension, Hypertension, Pulmonary, Length of Stay, Liver Diseases, Mitral Valve, Mitral Valve Stenosis, Mitral Valve Insufficiency, Pacemaker, Artificial, Patient Selection, Percutaneous Coronary Intervention, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Pulmonary Embolism, Pulmonary Veins, Pulsatile Flow, Quality Improvement, Quality of Life, Referral and Consultation, Registries, Reoperation, Renal Insufficiency, Research Personnel, Respiratory Insufficiency, Risk Factors, Smoking, Sodium, Spinal Cord Ischemia, Stroke, Stroke Volume, Surgeons, Surgical Instruments, Thrombosis, Tomography, X-Ray Computed, Transcatheter Aortic Valve Replacement, Treatment Outcome, Tricuspid Valve Insufficiency, Ventricular Dysfunction, Left, ACC Annual Scientific Session, ACC19

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