Stephen Fleet, MD

All posts by Stephen Fleet, MD

August 31st, 2011

TAVI—When Will It Come to an Operating Theater Near Me?

At the ESC meeting in Paris, Gerhard Schuler from Leipzig reviewed the current indications for Transcatheter Aortic Valve Implantation (TAVI). TAVI is considered appropriate for: Inoperable patients with severe aortic stenosis with a baseline 1-year mortality risk of 50%.  Patients with severe aortic stenosis and a surgical risk of greater than 15%. Valve-in-valve implantation for degenerated bioprosthetic […]

August 30th, 2011

Is Warfarin Still the First Choice in Atrial Fibrillation?

There’s an old maxim in medicine that one shouldn’t be the first to prescribe a new drug, nor the last. A fascinating debate between Michael Ezekowitz from the U.S. and Felicita Andreotti from Italy highlighted the differences between warfarin and the newer oral anticoagulants (NOACs) apixaban, rivaroxaban, and dabigatran. Even Dr. Ezekowitz, the warfarin protagonist for purposes […]

August 29th, 2011

ESC: A Closure Device and a Warfarin Substitute for High-Risk AFib Patients

How can we manage a patient with atrial fibrillation and contraindications to warfarin therapy such as recurrent severe bleeding — a common scenario in clinical practice? Data from the manufacturer-sponsored ASAP study (ASA Plavix Feasibility Study with WATCHMAN Left Atrial Appendage Closure Technology) provides some hope, beyond what we had learned from the Protect AF […]

August 28th, 2011

Anatomical vs. Physiological Assessment of Coronary Artery Disease

Just as the great voleur Willie Sutton robbed banks because “that’s where the money is,” why don’t we just look for coronary artery disease (CAD) directly in the coronary arteries? At the ESC meeting today in Paris, Bharati Shivalkar of Belgium reviewed the assessment of CAD utilizing coronary CT angiography (anatomical)  vs. the usual standard of care, stress […]