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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 -
Circulation Jul 1968
Review
Topics: Adult; Age Factors; Aortic Valve Stenosis; Heart Defects, Congenital; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 4894151
DOI: 10.1161/01.cir.38.1s5.v-61 -
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 -
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 -
Anesthesiology Clinics Sep 2009Calcific aortic stenosis (AS) is primarily a disease of the elderly, possessing features that are biomechanical as well as systemic and inflammatory in nature, with risk... (Review)
Review
Calcific aortic stenosis (AS) is primarily a disease of the elderly, possessing features that are biomechanical as well as systemic and inflammatory in nature, with risk factors and histopathology similar to atherosclerosis. To date no medical therapy has been shown to conclusively alter the progression of the disease, and for those with symptomatic AS, aortic valve replacement (AVR) is advocated. Factors that may alert the physician to an accelerated progression of calcific aortic valvular disease toward severe symptomatic AS include moderate aortic valve calcification, chronically dialyzed patients, and patients 80 years and older. There remains significant morbidity and mortality associated with AVR, and new techniques and technologies for AVR are being developed. For those who undergo successful AVR the long-term prognosis is good. A substantial number of patients with symptomatic AS present for anesthesia care for a variety of procedures. A thorough, modern understanding of AS and its course are necessary for the anesthesiologist to guide the patient through the perioperative period.
Topics: Aged; Aged, 80 and over; Anesthesia; Aortic Valve Stenosis; Disease Progression; Female; Humans; Retinal Detachment
PubMed: 19825490
DOI: 10.1016/j.anclin.2009.07.012 -
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 -
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 -
JAMA Cardiology Aug 2016
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 27434020
DOI: 10.1001/jamacardio.2016.2060 -
Der Internist Nov 2004Aortic valve stenosis is the most frequent reason for prosthetic valve replacement in adults. Its incidence increases with age. Development of the most frequent form,... (Review)
Review
Aortic valve stenosis is the most frequent reason for prosthetic valve replacement in adults. Its incidence increases with age. Development of the most frequent form, degenerative-calcific aortic stenosis, is related to atherosclerotic risk factors. The narrowing of the aortic valve orifice leads to creation of a systolic pressure drop, the gradient, between left ventricle and ascending aorta. The pressure overload from aortic stenosis causes concentric left ventricular hypertrophy and later heart failure. Typical symptoms of severe aortic stenosis include dyspnea, angina, and dizziness or syncope. On auscultation, a loud systolic murmur over the base of the heart is apparent, which is transmitted to the carotids. The ECG often shows left ventricular hypertrophy. The most important diagnostic technique is echocardiography, which allows to measure the gradient and to calculate the orifice area, which determine the degree of severity. The development of symptoms or impaired left ventricular function in severe aortic stenosis should prompt surgical treatment by valve replacement. Truly asymptomatic patients with preserved left ventricular function should be followed conservatively.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Ultrasonography
PubMed: 15459762
DOI: 10.1007/s00108-004-1285-5 -
Kardiologia Polska 2022
Topics: Humans; Constriction, Pathologic; Heart Valve Diseases; Aortic Valve; Aortic Valve Stenosis; Aortic Valve Insufficiency
PubMed: 35979642
DOI: 10.33963/KP.a2022.0195