Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal

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 emerging data supporting the use of TAVR among patients with asymptomatic, severe AS, bicuspid aortic valve (BAV) anatomy, and surgical bioprosthetic failure, but additional studies are needed.SummaryAs treatment options for managing patients with symptomatic, severe AS continue to grow at a rapid rate, it is essential to improve the recognition and diagnosis of the spectrum of clinical and hemodynamic presentations of severe AS. Despite the rapid expansion of TAVR, there remains a role for SAVR among a unique subset of patients. Future research should focus on optimizing the timing of valvular intervention while ensuring the acquisition of longer-term data on the durability of TAVR.
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology 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
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...
Source: Herz - Category: Cardiology Tags: Herz 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
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
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
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
Transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients with symptomatic aortic stenosis not eligible for surgical valve replacement due to a high periprocedural risk or comorbidities. However, there are several areas of debate concerning the pre-, intra- and post-procedural management. The standards and management for these topics may vary widely among different institutions and countries in Europe.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
ConclusionsData showed an improvement in morbidities/mortality for intermediate ‐risk patients treated with SAVR or TAVR. Increased funding allowed for a higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare costs. By incorporating important metrics such as length‐of‐stay, readmission rates, and complicat ions into decision‐making, the Heart‐Team can improve clinical outcomes, healthcare economics, and resource utilization.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Authors: Brito D, Goykhman I, Lo KB, Alhamshari Y, Peñalver JL, Aguilar F, Quintero E, Kalla A, Friend E, Pressman GS Abstract Aortic stenosis (AS) is common and increasing in prevalence as the population ages. Using computed tomography (CT) to quantify aortic valve calcification (AVC) it has been reported that men have greater degrees of calcification than women among subjects with severe AS. These data, however, were derived in largely Caucasian populations and have not been verified in non-Caucasian subjects. This retrospective study identified 137 patients with severe AS who underwent valve replacement a...
Source: Monaldi Archives for Chest Disease - Category: Respiratory Medicine Tags: Monaldi Arch Chest Dis Source Type: research
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