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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 -
International Journal of Molecular... Dec 2022Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the... (Review)
Review
Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.
Topics: Humans; Cardiovascular Diseases; Lipoprotein(a); Genome-Wide Association Study; Aortic Valve Stenosis; Risk Factors; Atherosclerosis
PubMed: 36613613
DOI: 10.3390/ijms24010170 -
PloS One 2021Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of...
BACKGROUND AND AIM OF THE STUDY
Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms.
MATERIALS AND METHODS
We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement.
RESULTS
Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients.
CONCLUSIONS
In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.
Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Asymptomatic Diseases; Case-Control Studies; Female; Heart Valve Prosthesis Implantation; Humans; Male; Prognosis; Retrospective Studies; Severity of Illness Index; Survival Rate
PubMed: 33826652
DOI: 10.1371/journal.pone.0249610 -
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 -
JACC. Cardiovascular Interventions Aug 2022It is unknown whether the sex difference whereby female transcatheter aortic valve replacement (TAVR) candidates had a lower risk profile, a higher incidence of...
BACKGROUND
It is unknown whether the sex difference whereby female transcatheter aortic valve replacement (TAVR) candidates had a lower risk profile, a higher incidence of in-hospital complications, but more favorable short- and long-term survival observed in tricuspid cohorts undergoing TAVR would persist in patients with bicuspid aortic valves (BAVs).
OBJECTIVES
The aim of this study was to reexamine the impact of sex on outcomes following TAVR in patients with BAVs.
METHODS
In this single-center study, patients with BAVs undergoing TAVR for severe aortic stenosis from 2012 to 2021 were retrospectively included. Baseline characteristics, aortic root anatomy, and in-hospital and 1-year valve hemodynamic status and survival were compared between sexes.
RESULTS
A total of 510 patients with BAVs were included. At baseline, women presented with fewer comorbidities. Men had a greater proportion of Sievers type 1 BAV, higher calcium volumes (549.2 ± 408.4 mm vs 920.8 ± 654.3 mm; P < 0.001), and larger aortic root structures. Women experienced more vascular complications (12.9% vs 4.9%; P = 0.002) and bleeding (11.1% vs 5.3%; P = 0.019) and higher residual gradients (16.9 ± 7.7 mm Hg vs 13.2 ± 6.4 mm Hg; P < 0.001), while men were more likely to undergo second valve implantations during index TAVR (6.3% vs 15.9%; P = 0.001). Death at 1 year was not significantly different between sexes (HR: 1.15; 95% CI: 0.56-2.35; P = 0.70). Bleeding (adjusted HR: 4.62; 95% CI: 1.51-14.12; P = 0.007) was the single independent predictor of 1-year death for women.
CONCLUSIONS
In patients with BAVs undergoing TAVR, women presented with fewer comorbidities, while men had a greater proportion of type 1 BAV, more calcification, and larger aortic roots. In-hospital outcomes favored men, with fewer complications except for the need for second valve implantation, but 1-year survival was comparable between sexes.
Topics: Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Female; Humans; Male; Retrospective Studies; Sex Characteristics; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35981839
DOI: 10.1016/j.jcin.2022.06.036