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La Revue de Medecine Interne Mar 2022Aortic stenosis remains one of the most frequent valvulopathy worldwide, burdened with great mortality and morbidity, and for which there is not yet an effective... (Review)
Review
Aortic stenosis remains one of the most frequent valvulopathy worldwide, burdened with great mortality and morbidity, and for which there is not yet an effective preventive approach, although the pathophysiological mechanisms involved in its development are better understood nowadays. Its cure, however, has been revolutionized in the last decade by the advent of transcatheter aortic valve implantation, or TAVI (also named transcatheter aortic valve replacement or TAVR). The technique of TAVI has been refined and its indications has been extended, following the publication of large randomized controlled trials where it was compared to surgical aortic valve replacement with favorable results. Consequently, transfemoral TAVR has become the first line of treatment in case of symptomatic severe aortic valve stenosis. In this review, we describe the pathophysiological mechanisms leading to severe aortic stenosis and the main ongoing randomized controlled trials targeting them. We describe the indication for surgical or percutaneous aortic valve replacement and the main complications following the procedure.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35181161
DOI: 10.1016/j.revmed.2021.06.003 -
Journal of the American College of... Aug 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Severity of Illness Index; Stroke Volume; Ventricular Function, Left
PubMed: 35953134
DOI: 10.1016/j.jacc.2022.05.037 -
The American Journal of Medicine Apr 2017Aortic stenosis is the most common valvular heart disease leading to intervention, and it is typically a disease of the elderly. Recent clinical advances have expanded... (Review)
Review
Aortic stenosis is the most common valvular heart disease leading to intervention, and it is typically a disease of the elderly. Recent clinical advances have expanded the role of transcatheter aortic valve intervention in patients with severe aortic stenosis, making aortic valve intervention feasible and effective even in patients at intermediate, high, and prohibitive surgical risk. With the rapid advances in treatment, proper diagnosis becomes crucial for a wide range of patients with aortic stenosis: from "concordant" high-gradient aortic stenosis to "discordant" low-gradient aortic stenosis. The latter group commonly presents a clinical challenge requiring thoughtful and comprehensive evaluation to determine eligibility for aortic valve intervention. Providers at all levels should be familiar with basic diagnostic caveats and misconceptions when evaluating patients with possible aortic stenosis.
Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Contraindications; Echocardiography, Three-Dimensional; Exercise Test; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement; Ventricular Dysfunction, Left
PubMed: 28109966
DOI: 10.1016/j.amjmed.2016.12.025 -
Journal of the American College of... Dec 2020
Topics: Aortic Valve Stenosis; Crime; Diastole; Humans; Registries; Transcatheter Aortic Valve Replacement
PubMed: 33334423
DOI: 10.1016/j.jacc.2020.10.034 -
International Journal of Cardiology Sep 2021
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 34293365
DOI: 10.1016/j.ijcard.2021.07.032 -
Seminars in Dialysis May 2017Aortic valve stenosis occurs 10-20 years earlier in patients on dialysis compared with the general population. This is likely related to the exposure of the valve to a... (Review)
Review
Aortic valve stenosis occurs 10-20 years earlier in patients on dialysis compared with the general population. This is likely related to the exposure of the valve to a milieu that predisposes to calcification as well as increased shear stress across the valve. Objective assessment of stenosis severity is largely made using echocardiography though accurate interpretation requires an understanding of the potential pitfalls of the technique and the influence of cardiac output upon the gradient measured across the valve. Timing of valve replacement in severe aortic stenosis is predominantly guided by exercise-induced symptoms (breathlessness, chest pain and [pre] syncope), which are often difficult to assess in the dialysis population who may have limited exercise capacity and symptoms due to renal failure and other comorbidities. Finally, treatment of aortic stenosis remains a constantly evolving area with advances in both conventional surgery and percutaneous techniques.
Topics: Aortic Valve Stenosis; Echocardiography; Global Health; Humans; Incidence; Kidney Failure, Chronic; Renal Dialysis; Risk Assessment
PubMed: 28239994
DOI: 10.1111/sdi.12582 -
Heart, Lung & Circulation Sep 2019Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries.... (Review)
Review
Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.
Topics: Aortic Valve; Aortic Valve Stenosis; Calcinosis; Echocardiography; Echocardiography, Stress; Hemodynamics; Humans; Multimodal Imaging; Transcatheter Aortic Valve Replacement
PubMed: 31266725
DOI: 10.1016/j.hlc.2019.05.177 -
European Heart Journal. Cardiovascular... Apr 2022
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 35175351
DOI: 10.1093/ehjci/jeac040 -
The Canadian Journal of Cardiology Aug 2022
Topics: Acute Coronary Syndrome; Aortic Valve Stenosis; Coronary Stenosis; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention
PubMed: 35568267
DOI: 10.1016/j.cjca.2022.05.006 -
Comprehensive Physiology Jun 2017The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical... (Review)
Review
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR). AVS is the most commonly encountered valve disease nowadays and affects almost 5% of elderly population. In particular, AVS poses a great challenge due to the multiple comorbidities and frailty of this patient subset. MR is also a common valve pathology and has an estimated prevalence of 3% in the general population, affecting more than 176 million people worldwide. This review will focus on pathophysiological changes in both these valve diseases, starting from the description of the anatomical aspects of normal valve, highlighting all the main cellular and molecular features involved in the pathological progression and cardiac consequences. This review also evaluates the main approaches in clinical management of these valve diseases, taking into account of the main published clinical guidelines. © 2017 American Physiological Society. Compr Physiol 7:799-818, 2017.
Topics: Aortic Valve Stenosis; Humans; Mitral Valve Insufficiency; Oxidative Stress; Signal Transduction
PubMed: 28640443
DOI: 10.1002/cphy.c160020