1
|
Redwood S, Patterson T, Androshchuk V. Lifetime Management of Aortic Stenosis: Initial TAVR Device Selection Matters. JACC Cardiovasc Interv 2025; 18:226-228. [PMID: 39453375 DOI: 10.1016/j.jcin.2024.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 10/26/2024]
Affiliation(s)
- Simon Redwood
- School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
| | - Tiffany Patterson
- Cardiovascular Department, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Vitaliy Androshchuk
- School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| |
Collapse
|
2
|
Lella SK, Ferrell BE, Sugiura T. Contemporary Management of the Aortic Valve-Narrative Review of an Evolving Landscape. J Clin Med 2024; 14:134. [PMID: 39797217 PMCID: PMC11722002 DOI: 10.3390/jcm14010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/25/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Background: Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, a number of minimally invasive and interventional treatment options have allowed for the treatment of high and prohibitive risk surgical patients. Further, technology is allowing for the development of innovative surgical and transcatheter valve models, which will advance the treatment of aortic valve disease in the future. Objective: Here, we choose to describe the modern aortic valve replacement techniques and the available valves and designs.
Collapse
Affiliation(s)
- Srihari K. Lella
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Brandon E. Ferrell
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
| | - Tadahisa Sugiura
- Division of Cardiothoracic Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA; (S.K.L.); (B.E.F.)
- Montefiore Medical Center, Department of Cardiothoracic and Vascular Surgery, Medical Arts Pavilion, 3400 Bainbridge Road, 5th Floor, Bronx, NY 10467, USA
| |
Collapse
|
3
|
Sohn SH, Kim KH, Kang Y, Choi JW, Lee SH, Shinn SH, Yoo JS, Lim C. Costs Associated with Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Korea. J Chest Surg 2024; 57:536-546. [PMID: 39434612 PMCID: PMC11538586 DOI: 10.5090/jcs.24.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 10/23/2024] Open
Abstract
Background This study compared the costs associated with transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in Korea by utilizing the National Health Insurance Service database. Methods Between June 2015 and May 2019, 1,468 patients underwent primary isolated transfemoral TAVI, while 2,835 patients received primary isolated SAVR with a bioprosthesis. We assessed the costs of index hospitalization and subsequent healthcare utilization, categorizing the cohort into 6 age subgroups: <70, 70-74, 75-79, 80-84, 85-89, and ≥90 years. The median follow-up periods were 2.5 and 3.0 years in the TAVI and SAVR groups, respectively. Results The index hospitalization costs were 41.0 million Korean won (KRW) (interquartile range [IQR], 39.1-44.7) for the TAVI group and 24.6 million KRW (IQR, 21.3-30.2) for the SAVR group (p<0.001). The TAVI group exhibited relatively constant index hospitalization costs across different age subgroups. In contrast, the SAVR group showed increasing index hospitalization costs with advancing age. The healthcare utilization costs were 5.7 million KRW per year (IQR, 3.3-14.2) for the TAVI group and 4.0 million KRW per year (IQR, 2.2-9.0) for the SAVR group (p<0.001). Healthcare utilization costs were higher in the TAVI group than in the SAVR group for the age subgroups of <70, 70-74, and 75-79 years, and were comparable in the age subgroups of 80-84, 85-89, and ≥90 years. Conclusion TAVI had much higher index hospitalization costs than SAVR. Additionally, the overall healthcare utilization costs post-discharge for TAVI were also marginally higher than those for SAVR in younger age subgroups.
Collapse
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
4
|
Carulli E, Browne S, Woolley S, Tindale A, Pottle A, Nagle K, Lane R, Chandra N, Patel N, De Palma R, Barnes G, Kabir T, Panoulas V, Smith D, Smith R, Clernon S, Heng EL, Akhtar M, Bowers M, McGovern I, Lüscher T, Dalby M. Implementing and evaluating shared decision-making before transcatheter aortic valve implantation with a dedicated pathway and questionnaire. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae095. [PMID: 39678759 PMCID: PMC11643346 DOI: 10.1093/ehjopen/oeae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/27/2024] [Accepted: 10/08/2024] [Indexed: 12/17/2024]
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic valve stenosis. The choice between TAVI, surgery, or a conservative approach should be based upon multiple factors including clinical considerations, technical feasibility, and informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused. Methods and results To comply with the European and UK national guidelines, in January 2023 we established a structured SDM pathway in which patients are offered virtual/physical decision aids and after 1 week are invited to a meeting to reach a shared decision. From December 2022 to June 2023, a custom-developed questionnaire was prospectively administered to 23 patients prior to, and 38 patients after, the implementation of the SDM pathway. The answers to 12 core questions were recorded on a Likert scale (1-5). Global satisfaction, as measured by mean Likert score, was significantly higher for the post-SDM group than for the pre-SDM group (4.46 ± 0.14 vs. 3.78 ± 0.30, P < 0.001). The percentage of positive (Likert 4-5) responses was significantly higher in the post-SDM group (289/312, 92.6% vs. 155/234, 66.2%, P < 0.001). The percentage of negative (Likert 1-2) responses was significantly lower in the post-SDM group (5/312, 1.6% vs. 53/234, 22.6%, P < 0.001). Conclusion The SDM pathway proved effective in delivering SDM in compliance with national and international guidance. A similar approach leveraging digital technology to minimize cost and enhance patient convenience could be implemented for other treatments and across other institutions.
Collapse
Affiliation(s)
- Ermes Carulli
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Doctoral School in Translational Medicine, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Suzy Browne
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Sara Woolley
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Alexander Tindale
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Alison Pottle
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Kate Nagle
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Rebecca Lane
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Navin Chandra
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Portsmouth Road, Frimley GU16 7U, UK
| | - Niket Patel
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Rodney De Palma
- Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, Aylesbury HP21 8AL, UK
| | - Gareth Barnes
- Ashford and St Peter's Hospitals NHS Foundation Trust, St Peters Hospital, Guildford Road, Chertsey KT16 0PZ, UK
| | - Tito Kabir
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Vasileios Panoulas
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - David Smith
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Robert Smith
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Sharon Clernon
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Ee Ling Heng
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Mohammed Akhtar
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Mark Bowers
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Ian McGovern
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
| | - Thomas Lüscher
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Miles Dalby
- Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Department of Cardiology, Hill End Rd, Harefield, Uxbridge UB9 6JH, UK
- Imperial College London, Exhibition Road, London SW7 2AZ, UK
| |
Collapse
|
5
|
Mauler-Wittwer S, Giannakopoulos G, Arcens M, Noble S. Degenerated Transcatheter Aortic Valve Replacement: Investigation and Management Options. Can J Cardiol 2024; 40:300-312. [PMID: 38072363 DOI: 10.1016/j.cjca.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
With the expansion of transcatheter aortic valve replacement (TAVR) to younger and lower-surgical-risk patients, many younger and less comorbid patients will be treated with TAVR and are expected to have a life expectancy that will exceed the durability of their transcatheter heart valve. Consequently, the number of patients requiring reintervention will undoubtedly increase in the near future. Redo-TAVR and TAVR explantation followed by surgical aortic valve replacement are the different therapeutic options in the event of bioprosthetic valve failure and the need for reintervention. Patients often anticipate being able to benefit from a redo-TAVR in the event of bioprosthetic valve failure after TAVR, despite the lack of long-term data and the risk of unfavourable anatomy. Our understanding of the feasibility of redo-TAVR is constantly improving thanks to bench test studies and growing worldwide experience. However, much remains unknown. In clinical practice, one of the heart team's objectives is to anticipate the need to reaccess the coronary arteries and implant a second or even a third valve when life expectancy may exceed the durability of the transcatheter heart valve. In this review, we address key definitions in the diagnosis of structural valve deterioration and bioprosthetic valve failure, as well as patient selection and procedural planning for redo-TAVR to reduce periprocedural risk, optimise hemodynamic performance, and maintain coronary access. We describe the bench testing and literature in the redo-TAVR and TAVR explantation fields.
Collapse
Affiliation(s)
| | | | - Marc Arcens
- Structural Heart Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Stéphane Noble
- Structural Heart Unit, University Hospital of Geneva, Geneva, Switzerland.
| |
Collapse
|
6
|
Wang X, Arslani K, Nuyens P, Montarello NJ, Vanhaverbeke M, Bieliauskas G, Sondergaard L, De Backer O. Contemporary guideline-directed management of patients with severe aortic valve stenosis. EUROINTERVENTION 2024; 20:e158-e167. [PMID: 38224253 PMCID: PMC10786179 DOI: 10.4244/eij-d-23-00469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/15/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are Class Ia recommended therapies for specific subgroups of severe aortic stenosis (AS) patients in the latest 2021 European guidelines. AIMS We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations. METHODS All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded. RESULTS The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days). CONCLUSIONS TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
Collapse
Affiliation(s)
- Xi Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ketina Arslani
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Šolc AJ, Línková H, Toušek P. Transcatheter aortic valve durability, predictors of bioprosthetic valve dysfunction, longer-term outcomes - a review. Expert Rev Med Devices 2024; 21:15-26. [PMID: 38032186 DOI: 10.1080/17434440.2023.2288275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is one of the most significant inventions in cardiology, as it provides a viable minimally invasive treatment option for patients with aortic stenosis, the most common valvular disease in the developed world and one with a poor prognosis when left untreated. Using data available to date, this review aims to discuss and identify possible predictors of TAVI valve durability - an essential requirement for the device's wide-spread use, especially in younger patients. AREAS COVERED This article explores the main causes of bioprosthetic valve dysfunction (BVD) based on pathophysiology and available data, and reviews possible predictors of BVD including prosthesis-related, procedure-related, and patient-related factors. An emphasis is made on affectable predictors, which could potentially be targeted with prevention management and improve valve durability. A literature search of online medical databases was conducted using relevant key words and dates; significant clinical trials were identified. A brief overview of important randomized controlled trials with mid to long-term follow-up is included in this article. EXPERT OPINION Identifying modifiable predictors of valve dysfunction presents an opportunity to enhance and predict valve durability - a necessity as patients with longer life-expectancies are being considered for the procedure.
Collapse
Affiliation(s)
- Abigail Johanna Šolc
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Hana Línková
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| |
Collapse
|
8
|
Linker DT. Expanding Use of Transcatheter (Expandible) Aortic Valves: Too Much, Just Right, or Not Enough? Am J Cardiol 2023; 206:368-369. [PMID: 37722972 DOI: 10.1016/j.amjcard.2023.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Affiliation(s)
- David T Linker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
| |
Collapse
|
9
|
Lerman TT, Levi A, Jørgensen TH, Søndergaard L, Talmor-Barkan Y, Kornowski R. Comparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs. Front Cardiovasc Med 2023; 10:1242608. [PMID: 37771663 PMCID: PMC10525352 DOI: 10.3389/fcvm.2023.1242608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
Background This study aims to compare valve durability between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Methods We conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The primary outcome was structural valve deterioration (SVD). Secondary outcomes were bioprosthetic valve failure, reintervention, effective orifice area (EOA), mean pressure gradient, and moderate-severe aortic regurgitation (AR, transvalvular and/or paravalvular). Results Twenty-five publications from seven RCTs consisting of 7,970 patients were included in the analysis with follow-up ranges of 2-8 years. No significant difference was found between the two groups with regard to SVD [odds ratio (OR) 0.72; 95% CI: 0.25-2.12]. The TAVI group was reported to exhibit a statistically significant higher risk of reintervention (OR 2.03; 95% CI: 1.34-3.05) and a moderate-severe AR (OR 6.54; 95% CI: 3.92-10.91) compared with the SAVR group. A trend toward lower mean pressure gradient in the TAVI group [(mean difference (MD) -1.61; 95% CI: -3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08-0.31) was noted. Conclusion The present data indicate that TAVI provides a comparable risk of SVD with favorable hemodynamic profile compared with SAVR. However, the higher risk of significant AR and reintervention was demonstrated. Systematic Review Registration PROSPERO (CRD42022363060).
Collapse
Affiliation(s)
- Tsahi T. Lerman
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Troels Højsgaard Jørgensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|