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The American Journal of Medicine Mar 2017The incidence of aortic stenosis increases with age, affecting up to 10% of the population by the eighth decade. Once symptoms develop, aortic stenosis is rapidly fatal.... (Review)
Review
The incidence of aortic stenosis increases with age, affecting up to 10% of the population by the eighth decade. Once symptoms develop, aortic stenosis is rapidly fatal. Proper management requires an understanding of the physiology and criteria used to define disease severity. There is no effective pharmacologic treatment. Surgical aortic valve replacement has been the gold standard treatment for decades. However, over the last 10 years transcatheter aortic valve replacement has emerged as an attractive, less-invasive option for appropriately selected patients. Refinements in valve design and delivery systems have led to widespread use of this breakthrough technology in selected patients. We review the pathophysiology, criteria for valve replacement, and the results of the trials comparing transcatheter aortic valve replacement with surgical aortic valve replacement.
Topics: Aortic Valve; Aortic Valve Stenosis; Asymptomatic Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans
PubMed: 27810479
DOI: 10.1016/j.amjmed.2016.10.005 -
Mayo Clinic Proceedings Apr 2018With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of... (Review)
Review
With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of aortic stenosis are of paramount importance because untreated symptomatic severe disease is universally fatal. The advent of transcather aortic valve replacement technologies provides exciting avenues of care to patients with this disease in whom traditional surgical procedures could not be performed or were associated with high risk. This review for clinicians offers an overview of aortic stenosis and updated information on the current status of various treatment strategies. An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was performed from conception July 1, 2016, through November 30, 2017, using the terms aortic stenosis, aortic valve replacement, transcatheter aortic valve replacement (TAVR), transcatheter aortic valve insertion (TAVI), surgical aortic valve replacement, aortic stenosis flow-gradient patterns, low-flow aortic valve stenosis, natural history, stress testing, pathophysiology, bicuspid aortic valve, and congenital aortic valve disease.
Topics: Age Factors; Aortic Valve Stenosis; Cardiac Catheterization; Disease Progression; Echocardiography, Doppler; Female; Heart Valve Prosthesis Implantation; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Prevalence; Randomized Controlled Trials as Topic; Risk Factors; Severity of Illness Index
PubMed: 29622096
DOI: 10.1016/j.mayocp.2018.01.020 -
Cardiology Clinics Feb 2020Calcific aortic valve stenosis is the commonest form of heart valve disease in high-income countries and set to become a major health care burden. Currently, there are... (Review)
Review
Calcific aortic valve stenosis is the commonest form of heart valve disease in high-income countries and set to become a major health care burden. Currently, there are no medical therapies that have proved to slow down or halt disease progression. The only available treatment is aortic valve replacement, of which the optimal timing is unknown and to which not all patients are suited. This review discusses the pathophysiology of aortic stenosis, how noninvasive imaging techniques have improved our understanding of the underlying biology, and how these emerging insights might translate into potential novel treatments targeting oxidized lipids, fibrosis, and calcification.
Topics: Aortic Valve Stenosis; Humans
PubMed: 31753168
DOI: 10.1016/j.ccl.2019.09.010 -
Cardiology Clinics Feb 2020Current guidelines for management of adults with aortic stenosis recommend aortic valve replacement for patients with clinical consequences due to hemodynamically severe... (Review)
Review
Current guidelines for management of adults with aortic stenosis recommend aortic valve replacement for patients with clinical consequences due to hemodynamically severe valve obstruction. However, advances in surgical and transcatheter techniques, and improved valve design have led to decreased procedural risk and improved long-term outcomes. Transcatheter aortic valve replacement (TAVR) is recommended for patients with prohibitive surgical risk and is reasonable in intermediate and high-risk patients. Recent trials demonstrated favorable short-term outcomes in patients with low surgical risk undergoing TAVR compared with surgical AVR. We review the current Guidelines recommendations and highlight key controversies in management due to evidence gaps.
Topics: Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Practice Guidelines as Topic; Risk Assessment; Ventricular Dysfunction, Left
PubMed: 31753177
DOI: 10.1016/j.ccl.2019.09.003 -
Circulation Nov 2016Untreated, severe, symptomatic aortic stenosis is associated with a dismal prognosis. The only treatment shown to improve survival is aortic valve replacement; however,... (Review)
Review
Untreated, severe, symptomatic aortic stenosis is associated with a dismal prognosis. The only treatment shown to improve survival is aortic valve replacement; however, before symptoms occur, aortic stenosis is preceded by a silent, latent phase characterized by a slow progression at the molecular, cellular, and tissue levels. In theory, specific medical therapy should halt aortic stenosis progression, reduce its hemodynamic repercussions on left ventricular function and remodeling, and improve clinical outcomes. In the present report, we performed a systematic review of studies focusing on the medical treatment of patients with aortic stenosis. Lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy have been the main drug classes studied in this setting and are reviewed in depth. A critical appraisal of the preclinical and clinical evidence is provided, and future research avenues are presented.
Topics: Aortic Valve Stenosis; Humans
PubMed: 27895025
DOI: 10.1161/CIRCULATIONAHA.116.023997 -
Journal of Cardiac Surgery Dec 2019Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of... (Review)
Review
Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints.
Topics: Aortic Valve Stenosis; Humans; Patient Selection; Transcatheter Aortic Valve Replacement
PubMed: 31600005
DOI: 10.1111/jocs.14226 -
Circulation Research Apr 2021Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over... (Review)
Review
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
Topics: Aged; Aged, 80 and over; Allografts; Aortic Valve Stenosis; Balloon Valvuloplasty; Bioprosthesis; Clinical Decision-Making; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Prosthesis Design; Prosthesis Failure; Pulmonary Valve; Symptom Assessment; Transcatheter Aortic Valve Replacement
PubMed: 33914604
DOI: 10.1161/CIRCRESAHA.121.318040 -
Heart (British Cardiac Society) Jan 2022
Topics: Aortic Valve Stenosis; Calcinosis; Humans; Lipoprotein(a)
PubMed: 34611044
DOI: 10.1136/heartjnl-2021-320173 -
The New England Journal of Medicine Oct 2023
Topics: Humans; Angiodysplasia; Aortic Valve Stenosis; Gastrointestinal Hemorrhage; Vascular Diseases; Gastrointestinal Diseases
PubMed: 37851881
DOI: 10.1056/NEJMc2306027 -
Journal of the American College of... Nov 2023
Topics: Humans; Aortic Valve Stenosis; Aortic Valve; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis; Treatment Outcome; Prosthesis Design; Risk Factors
PubMed: 37877907
DOI: 10.1016/j.jacc.2023.09.813