PENGARUH JENIS KOTORAN TERNAK SEBAGAI SUBSTRAT DENGAN PENAMBAHAN SERASAH DAUN JATI (Tectona grandis) TERHADAP KARAKTERISTIK BIOGAS PADA PROSES FERMENTASI

Abstract

Background: At least 30% of patients with severe asymptomatic aortic stenosis do not undergo sAVR. Transcatheter Aortic Valve Implantation (TAVI) provides a potential option for those patients. Many centers have established a dedicated aortic clinic to evaluate those patients. However, the impact of those clinics on sAVR volume and outcomes remains unclear. Methods: The University of Pittsburgh started an aortic valve clinic in September 2010 staffed by an interventional cardiologist and a cardiac surgeon to evaluate potential TAVI candidates. Actual implants began in Januaray 2011. We compared the sAVR volume and outcomes in the 12 months prior to opening the clinic (July 2009- June 2010) to the 12 months folllowing that (Jan 2011-Dec2011). We excluded the transition from July- December 2010. Results: 462 sAVRs were performed between July 2009-June 2010 compared to 564 from Jan 2011-Dec 2011 (22% increase), of those, 41 patients were initially referred for TAVI as they were deemed nonsurgical candidates by their referring cardiologist and underwent sAVR (average STS score 5.3%). The average STS risk score and in hospital surgical mortality for the patients undergoing sAVR prior to establishing valve clinic was 5.0%, and 7.2%, respectively compared to 5.7%, and 6.4% respectively. (Table Presented) Conclusions: Establishing a dedicated aortic valve clinic was associated with increase in sAVR volume. A significant proportion of that increase is from patients whose surgical risk has been overestimated by their treating physician and deemed nonsurgical candidates. This increase in volume was not associated with increase surgical mortality.