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JACC. Cardiovascular Interventions Oct 2021
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome; Tricuspid Valve Insufficiency
PubMed: 34600875
DOI: 10.1016/j.jcin.2021.08.026 -
Journal of the American Heart... Apr 2020Transcatheter aortic valve replacement is a relatively recent revolutionary treatment that has now become a standard procedure for treating severe aortic stenosis. In... (Review)
Review
Transcatheter aortic valve replacement is a relatively recent revolutionary treatment that has now become a standard procedure for treating severe aortic stenosis. In this article, the authors review the clinical history of transcatheter aortic valve replacement, summarize the major clinical trials, and describe the evolution of the technique over time. In doing so, the authors hope to provide a clear and concise review of the history and clinical evidence behind transcatheter aortic valve replacement.
Topics: Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Female; Humans; Male; Patient Safety; Postoperative Complications; Program Evaluation; Recovery of Function; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 32301367
DOI: 10.1161/JAHA.120.015921 -
Heart (British Cardiac Society) Sep 2020
Topics: 1-Alkyl-2-acetylglycerophosphocholine Esterase; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Humans; Lipids
PubMed: 32636297
DOI: 10.1136/heartjnl-2020-317188 -
The Journal of Thoracic and... Apr 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Blood Flow Velocity; Humans; Simvastatin
PubMed: 31928820
DOI: 10.1016/j.jtcvs.2019.10.161 -
Myocardial Damage and Severe Aortic Stenosis: Looking Beyond the Left Ventricular Ejection Fraction.Journal of the American College of... Aug 2021
Topics: Aortic Valve Stenosis; Humans; Stroke Volume; Transcatheter Aortic Valve Replacement; Ventricular Function, Left
PubMed: 34353532
DOI: 10.1016/j.jacc.2021.05.046 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Oct 2021Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low-risk patient cohorts....
Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low-risk patient cohorts. Direct aortic (DAo) route may be used in patients with severe peripheral vascular disease. Here, we present an 88-year old patient hospitalized with cardiogenic shock. Echocardiography revealed severe aortic valve stenosis with aortic valve area 0.5 cm², mean gradient of 55 mmHg, and peak gradient 92 mmHg. TAVI was considered by the Institutional Heart Team. Multislice computed tomography (MSCT) revealed severe peripheral vascular disease, decreased calibration of abdominal aorta, and multiple large vulnerable atherosclerotic plaques. The patient was scheduled for a DAo TAVI. A 26-mm Medtronic CoreValve Evolut R valve was implanted after predilatation with median sternotomy. The patient was discharged after 96 hours. Although transfemoral (TF) access is used as the default approach for TAVI, it was contraindicated in our patient owing to severe peripheral vascular disease and decreased calibration of the abdominal aorta at its narrowest point (4.5 mm) with multiple large vulnerable atherosclerotic plaques. Careful preprocedural MSCT evaluation is essential and directly affects the success of the procedure. MSCT is also mandatory to confirm the best cannulation zone that must be met for a successful DAo TAVI.
Topics: Aged, 80 and over; Aortic Valve Stenosis; Diagnosis, Differential; Femoral Artery; Humans; Male; Multidetector Computed Tomography; Peripheral Vascular Diseases; Shock, Cardiogenic; Transcatheter Aortic Valve Replacement
PubMed: 34623302
DOI: 10.5543/tkda.2021.21018 -
Journal of the American College of... Nov 2019Underserved minorities make up a disproportionately small subset of patients in the United States undergoing transcatheter and surgical aortic valve replacement for... (Review)
Review
Underserved minorities make up a disproportionately small subset of patients in the United States undergoing transcatheter and surgical aortic valve replacement for aortic stenosis. The reasons for these treatment gaps include differences in disease prevalence and patient, health care system, and disease-related factors. This has major implications not only for minority patients, but also for other groups who face similar challenges in accessing state-of-the-art care for structural heart disease. The authors propose the following key strategies to address these treatment disparities: 1) implementation of measure-based quality improvement programs; 2) effective culturally competent communication and team-based care; 3) improving patient health care access, education, and effective diagnosis; and 4) changing the research paradigm that creates an innovation pipeline for patients. Only a concerted effort from all stakeholders will achieve equitable and broad application of this and other novel structural heart disease treatment modalities in the future.
Topics: Aortic Valve Stenosis; Health Status Disparities; Healthcare Disparities; Humans; Vulnerable Populations
PubMed: 31672188
DOI: 10.1016/j.jacc.2019.08.1035 -
Cardiorenal Medicine 2023Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations, and this presents a diagnostic challenge as chronic kidney disease (CKD) and other... (Review)
Review
BACKGROUND
Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations, and this presents a diagnostic challenge as chronic kidney disease (CKD) and other commonly found comorbid conditions may present similarly. While medical optimization is an important aspect in management, aortic valve replacement (AVR) by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is the definitive treatment. Patients with concomitant CKD and AS require special consideration as it is known that CKD is associated with progression of AS and poor long-term outcomes.
AIMS AND OBJECTIVES
The aim of the study was to summarize and review the current existing literature on patients with both CKD and AS regarding disease progression, dialysis methods, surgical intervention, and postoperative outcomes.
CONCLUSION
The incidence of AS increases with age but has also been independently associated with CKD and furthermore with hemodialysis (HD). Regular dialysis with HD versus peritoneal dialysis (PD) and female gender have been associated with progression of AS. Management of AS is multidisciplinary and requires planning and interventions by the heart-kidney team to decrease the risk of further inducing kidney injury among high-risk population. Both TAVR and SAVR are effective interventions for patients with severe symptomatic AS, but TAVR has been associated with better short-term renal and cardiovascular outcomes.
IMPLICATIONS FOR PRACTICE
Special consideration must be given to patients with both CKD and AS. The choice of whether to undergo HD versus PD among patients with CKD is multifactorial, but studies have shown benefit regarding AS progression among those who undergo PD. The choice regarding AVR approach is likewise the same. TAVR has been associated with decreased complications among CKD patients, but the decision is multifactorial and requires a comprehensive discussion with the heart-kidney team as many other factors play a role in the decision including preference, prognosis, and other risk factors.
Topics: Humans; Female; Aortic Valve; Heart Valve Prosthesis Implantation; Treatment Outcome; Postoperative Complications; Aortic Valve Stenosis; Renal Insufficiency, Chronic
PubMed: 36812906
DOI: 10.1159/000529543 -
The Journal of Thoracic and... Aug 2021
Topics: Aortic Valve Disease; Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 32063356
DOI: 10.1016/j.jtcvs.2019.12.095 -
Scientific Reports May 2022Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS (aortic stenosis) severity, but it is unclear...
Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS (aortic stenosis) severity, but it is unclear that whether CT findings would have additional value to discriminate significant AS subtypes including high gradient severe AS, classic low-flow, low gradient (LF-LG) AS, paradoxical LF-LG AS, and moderate AS. In this study, we examined the preoperative clinical and cardiac CT findings of different subtypes of AS in patients with surgical aortic valve replacement (AVR) and evaluated the subtype classification as a factor affecting post-surgical outcomes. This study included 511 (66.9 ± 8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVA) and by CT (AVA) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as (1) high-gradient severe (n = 438), (2) classic LF-LG (n = 18), and (3) paradoxical LF-LG (n = 55) based on echocardiography. In all patients, 455 (89.0%) patients were categorized as severe AS according to the AVA. However, 56 patients were re-classified as moderate AS (43 [9.8%] high-gradient severe AS, 5 [27.8%] classic LF-LG AS, and 8 [14.5%] paradoxical LF-LG AS) by AVA. The classic LF-LG AS group presented larger AVA and aortic annulus than those in high-gradient severe AS group and one third of them had AVA ≥ 1.2 cm. After multivariable adjustment, old age (hazard ratio [HR], 1.04, P = 0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P < 0.001), preoperative atrial fibrillation (HR, 2.75; P = 0.003), classic LF-LG AS (HR, 5.53, P = 0.004), and small aortic annulus on CT (HR, 0.57; P = 0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE) after surgical AVR.
Topics: Aortic Valve; Aortic Valve Stenosis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Severity of Illness Index; Stroke Volume; Treatment Outcome
PubMed: 35525841
DOI: 10.1038/s41598-022-11491-3