Aortic stenosis-which diagnostic algorithms and which treatment?

[Aortic stenosis-which diagnostic algorithms and which treatment?] Herz. 2020 Oct 08;: Authors: Erbel R Abstract The progress in cardiology during the last 50 years can best be studied by looking at the diagnostics and treatment of patients with aortic valve stenosis. Previously, the clinical examination, electrocardiography (ECG) and chest X‑ray were used before heart catheterization, which included a transseptal puncture to complete the indications for surgery in young patients. Nowadays, echocardiography, often combined with a dobutamine stress test, is the primary diagnostic tool to which computed tomography for quantification of valve calcification and cardiac magnetic resonance imaging can be of additive value. The treatment of severe aortic valve stenosis is no longer only treated by aortic valve replacement but transluminal aortic valve implantation also represents a new therapeutic option. The change in the age groups of treated patients is also noteworthy. Surgery is recommended for patients under 75 years old but for older patients, especially those with a high risk, interventional catheter-assisted treatment is preferred. PMID: 33030560 [PubMed - as supplied by publisher]
Source: Herz - Category: Cardiology Tags: Herz Source Type: research

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Authors: Saito Y, Erik E L, Raval A, Gimelli G, Kurt M J, Osaki S Abstract Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehos...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
AbstractPurpose of reviewAppropriate management of asymptomatic patients with severe aortic stenosis (AS) is increasingly debated given recent improvements in options for aortic valve replacement (AVR). The goal of this review is to provide an updated approach to evaluation and management of patients with asymptomatic severe AS and to discuss the rationale for early AVR.Recent findingsRegistry data, retrospective studies, and one small randomized controlled clinical trial suggest a mortality benefit to AVR before symptom onset, although larger randomized trials are needed given potential biases of observational data. Other...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
AbstractPurpose of reviewWe aim to provide the cardiovascular clinician with an update on the classification and diagnosis of severe AS and an evidence-based guide to the treatment options available for severe, symptomatic AS.Recent findingsThe classification of AS is evolving with increasing recognition of hemodynamically distinct AS subtypes and the importance of transvalvular flow in both the diagnosis and management of severe AS. Transcatheter aortic valve replacement (TAVR) has continued to expand its safety and efficacy to include patients with symptomatic, severe AS at low risk for surgical AVR (SAVR). There is emer...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Conclusion: These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA2DS2-VASc score and eGFR are useful for risk stratification.Cerebrovasc Dis Extra 2020;10:116 –123
Source: Cerebrovascular Diseases Extra - Category: Neurology Source Type: research
Balloon aortic valvuloplasty (BAV) is indicated in patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic stenosis,1 either as palliative therapy for patients who are not candidates for valve replacement,2 or as a bridge to transcatheter (TAVR) or surgical aortic valve replacement (SAVR).1,3 Given the high morbidity and mortality associated with BAV, especially because it is performed not infrequently in critically ill patients, it is important to understand the effect of hospital procedural volume on outcomes following BAV.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
IJERPH, Vol. 17, Pages 7335: The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph17197335 Authors: Ilija Bilbija Milos Matkovic Marko Cubrilo Nemanja Aleksic Jelena Milin Lazovic Jelena Cumic Vladimir Tutus Marko Jovanovic Svetozar Putnik Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgita...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Review Source Type: research
AbstractPurposeThe SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI]>  15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI]>  50% and central apnoea index [CAI]>  10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical rel...
Source: Somnologie - Schlafforschung und Schlafmedizin - Category: Sleep Medicine Source Type: research
Authors: Laricchia A, Khokhar AA, Gallo F, Giannini F, Colombo A, Latib A, Mangieri A Abstract INTRODUCTION: The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. AREAS COVERED: The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not inc...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
Pathological remodeling of the myocardium has long been known to involve oxidant signaling, but strategies using systemic antioxidants have generally failed to prevent it. We sought to identify key regulators of oxidant-mediated cardiac hypertrophy amenable to targeted pharmacological therapy. Specific isoforms of the aquaporin water channels have been implicated in oxidant sensing, but their role in heart muscle is unknown. RNA sequencing from human cardiac myocytes revealed that the archetypal AQP1 is a major isoform. AQP1 expression correlates with the severity of hypertrophic remodeling in patients with aortic stenosis...
Source: Science Translational Medicine - Category: Biomedical Science Authors: Tags: Research Articles Source Type: research
Conclusion Patients with asymptomatic aortic valve stenosis have lower odds of all-cause and cardiovascular mortality when managed with early-AVR compared with conservative management. However, because of significant heterogeneity in the classification of asymptomatic patients, large scale studies are required.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Valvular heart disease Source Type: research
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