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The Surgical Clinics of North America Jun 2022Acquired diseases of the aortic and mitral valves are the most common cause of morbidity and mortality among Valvular heart diseases. Aortic stenosis (AS) is increasing... (Review)
Review
Acquired diseases of the aortic and mitral valves are the most common cause of morbidity and mortality among Valvular heart diseases. Aortic stenosis (AS) is increasing in incidence in the United States (4,43 US), driven largely by an aging demographic. Aortic valve replacement is the only effective treatment of AS and has a dramatic mortality benefit. Mitral valve regurgitation (MR) is the most common form of valvular heart disease (VHD) in the US, whereby MR is most often the result of mitral valve prolapse; rheumatic heart disease (RHD) is a more common etiology of MR in underdeveloped countries. interventions for MR in the US are increasing.
Topics: Aortic Valve Stenosis; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 35671771
DOI: 10.1016/j.suc.2022.01.008 -
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 -
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 -
Heart (British Cardiac Society) Dec 2022
Topics: Humans; Hemodynamics; Heart; Aortic Valve Stenosis; Coronary Circulation
PubMed: 36007936
DOI: 10.1136/heartjnl-2022-321587 -
Heart (British Cardiac Society) Jul 2020Aortic stenosis (AS) is a common valve disorder in an ageing population in western countries, and women, with longer life expectancy, comprise a substantial percentage... (Review)
Review
Aortic stenosis (AS) is a common valve disorder in an ageing population in western countries, and women, with longer life expectancy, comprise a substantial percentage of elderly patients with AS. Compared with men, women exhibit distinctive characteristics at the level of stenotic valve leaflets and subsequent compensatory responses of the left ventricle to chronic pressure overload, and in clinical presentation, consequences and response to intervention. Randomised controlled trials of transcatheter aortic valve implantation have yielded new evidence of sex differences in both short-term and long-term outcomes after intervention. A comprehensive knowledge of the existing evidence may inform our understanding of gender differences during assessment and treatment of patients with AS. In this paper, we review the available evidence regarding sex differences in AS in terms of symptoms, clinical presentation, anatomical differences and pathophysiological progression, management and outcomes after aortic valve replacement. Implications for further research are suggested.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Female; Health Status Disparities; Healthcare Disparities; Hemodynamics; Humans; Male; Middle Aged; Prognosis; Risk Assessment; Risk Factors; Sex Factors; Transcatheter Aortic Valve Replacement; Ventricular Function, Left; Ventricular Remodeling; Women's Health
PubMed: 32201373
DOI: 10.1136/heartjnl-2019-315407