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AORTIC STENOSIS

Aortic Stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America.1 It is present in approximately 2% of the general population with a rising prevalence in the elderly (up to 6% in patients above 85 years old).2-4

Symptomatic AS has significant effects on a patient’s health and quality of life5,6 and many will have cardiovascular and other comorbidities, for example, other valvular diseases, diabetes mellitus, hypertension and peripheral vascular disease.7-11

With the availability of prosthetic heart valves, SAVR has become the procedure of choice for AS.17

Clinical benefits of SAVR include:23,24

  • Survival benefit for patients with symptomatic severe AS
  • Estimated 3.5-fold reduction of all-cause mortality in asymptomatic, hemodynamically significant AS compared to watchful waiting
  • Symptom relief
  • Improvement of LV function


Isolated SAVR is associated with an in-hospital mortality of approximately 2.5% and operative mortality may vary between 3% for low-risk patients (STS-PROM <4%) to 13% for high-risk patients (STS-PROM >8%).25-31*
 

*STS-PROM=Society of Thoracic Surgeons predicted risk of mortality


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Cardiac imaging in AS - cardiac damage and morphology focus
 

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TAVI Summit - Cardiac imaging

Cardiac imaging in AS - cardiac damage
 

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TAVI Summit - Cardiac imaging and morphology

Cardiac imaging in AS - conduction system and morphology focus
 

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Cardiac imaging in AS - conduction system
 

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Cardiac imaging in AS - coronary access and morphology focus
 

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TAVI Summit - Cardiac imaging

Cardiac imaging in AS - coronary access
 

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Live case from Berlin on refining TAVI
 

H. Dreker, A. Unbehaun, M. Kukucka and Team SHIP

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PCR London Valves 2021: Navitor™ – impact of hemodynamics and coronary accessibility   

PCR LV 2021: Navitor™ Live-in-a-box

PCR London Valves 2021: Navitor™ with FlexNav™ Live-in-a box

EuroPCR 2022: TAVI 1yr outcomes

EuroPCR 2022: One-year outcomes from a next-gen TAVI device with an active sealing cuff

ESC 2021: HF & VHD Guidelines

ESC 2021: The Essentials of 2021 ESC Heart Failure and ESC/EACTS Guidelines for the management of valvular heart disease

References
  1. Falk V, Baumgartner H, Bax JJ et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616–664. doi.org/10.1093/ejcts/ezx324.
  2. Lindroos M, Kupari M, Heikkilä J et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol. 1993;21(5):1220–1225. doi.org/10.1016/0735-1097(93)90249-Z.
  3. Osnabrugge RLJ, Mylotte D, Head SJ et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002–1012. doi.org/10.1016/j.jacc.2013.05.015.
  4. d'Arcy JL, Coffey S, Loudon MA et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. Eur Heart J. 2016;37(47):3515–3522. doi.org/10.1093/eurheartj/ehw229.
  5. van Geldrop MWA, Heuvelman HJ, Kappetein AP et al. Quality of life among patients with severe aortic stenosis. Neth Heart J. 2013;21(1):21–27. doi.org/10.1007/s12471-012-0364-9.
  6. Oterhals K, Haaverstad R, Nordrehaug JE et al. Self-reported health status, treatment decision and survival in asymptomatic and symptomatic patients with aortic stenosis in a Western Norway population undergoing conservative treatment: a cross-sectional study with 18 months follow-up. BMJ Open. 2017;7(8):e016489. dx.doi.org/10.1136/bmjopen-2017-016489.
  7. Iung B, Baron G, Tornos P et al. Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007;32(11):609–661. doi.org/10.1016/j.cpcardiol.2007.07.002.
  8. Faggiano P, Frattini S, Zilioli V et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol. 2012;159(2):94–99. doi.org/10.1016/j.ijcard.2011.02.026.
  9. Maisano F, Worthley S, Rodés-Cabau J et al. Early commercial experience from transcatheter aortic valve implantation using the Portico™ bioprosthetic valve: 30-day outcomes in the multicentre PORTICO-1 study. EuroIntervention. 2018;14(8):886–893. doi.org/10.4244/EIJ-D-18-00343.
  10. Reardon MJ, Van Mieghem NM, Popma JJ et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376(14):1321–1331. doi.org/10.1056/NEJMoa1700456.
  11. Leon MB, Smith CR, Mack MJ et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–1620. doi.org/10.1056/NEJMoa1514616.
  12. Olszowska M. Pathogenesis and pathophysiology of aortic valve stenosis in adults. Pol Arch Med Wewn. 2011;121(11):409–413. www.mp.pl/paim/issue/article/1103/.
  13. Czarny MJ et al. Diagnosis and management of valvular aortic stenosis. Clin Med Insights Cardiol. 2014;8(Suppl 1):15–24. doi.org/10.4137/CMC.S15716.
  14. Nishimura RA, Otto CM, Bonow RO et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–e132. doi.org/10.1016/j.jtcvs.2014.05.014.
  15. Zakkar M, Bryan AJ, Angelini GD. Aortic stenosis: diagnosis and management. BMJ. 2016;355:i5425. doi.org/10.1136/bmj.i5425.
  16. Indolfi C, Bartorelli AL, Berti S et al. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. J Cardiovasc Med (Hagerstown). 2018;19(5):197–210. doi.org/10.2459/JCM.0000000000000636.
  17. Grimard BH, Safford RE, Burns EL. Aortic stenosis: diagnosis and treatment. Am Fam Physician. 2016;93(5):371–378. www.aafp.org/pubs/afp/issues/2016/0301/p371.html.
  18. Vahanian A, Beyersdorf F, Praz F et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561–632. doi.org/10.1093/eurheartj/ehab395
  19. Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc. 2018;93(4):488-508. doi.org/10.1016/j.mayocp.2018.01.020.
  20. “Aortic Valve Stenosis - Diagnosis and Treatment - Mayo Clinic.” Aortic Valve Stenosis - Diagnosis and Treatment - Mayo Clinic, 18 August 2022, www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145 (accessed May 2023).
  21. Ram E, Sternik L, Lipey A, et al. Clinical and echocardiographic outcomes after aortic valve repair in patients with bicuspid or unicuspid aortic valve. Isr Med Assoc J. 2018;20(7):423–428. www.ima.org.il/FilesUploadPublic/IMAJ/0/294/147319.pdf.
  22. Martín M, Lorca R, Rozado J, et al. Bicuspid aortic valve syndrome: a multidisciplinary approach for a complex entity. J Thoracic Dis. 2017;9(Suppl 6):S454–S464. doi.org/10.21037/jtd.2017.05.11.
  23. Généreux P, Stone GW, O'Gara PT et al. Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2016;67(19):2263–2288. doi.org/10.1016/j.jacc.2016.02.057.
  24. Lund O. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation. 1990;82(1):124–139. doi.org/10.1161/01.CIR.82.1.124.
  25. Nashef SA, Roques F, Sharples LD et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–744;discussion 744–745. doi.org/10.1093/ejcts/ezs043.
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  28. Thourani VH, Suri RM, Gunter RL et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg. 2015;99(1):55–61. doi.org/10.1016/j.athoracsur.2014.06.050.
  29. Brown JM, O’Brien SM, Wu C et al. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137(1):82–90. doi.org/10.1016/j.jtcvs.2008.08.015.
  30. Culler SD, Cohen DJ, Brown PP et al. Trends in aortic valve replacement procedures between 2009 and 2015: has transcatheter aortic valve replacement made a difference? Ann Thorac Surg. 2018;105(4):1137–1143. doi.org/10.1016/j.athoracsur.2017.10.057.
  31. O'Brien SM, Shahian DM, Filardo G et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery. Ann Thorac Surg. 2009; 88(1 Suppl):S23–42. doi.org/10.1016/j.athoracsur.2009.05.056.
  32. Durko AP, Osnabrugge RL, Kappetein AP. Long-term outlook for transcatheter aortic valve replacement. Trends Cardiovasc Med. 2018;28(3):174–183. doi.org/10.1016/j.tcm.2017.08.004.
  33. McDonagh TA, Metra M, Adamo M et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726. doi.org/10.1093/eurheartj/ehab368.
  34. Filardo G, Hamilton C, Hamman B et al. New-onset postoperative atrial fibrillation and long-term survival after aortic valve replacement surgery. Ann Thorac Surg. 2010;90(2):474–479. doi.org/10.1016/j.athoracsur.2010.02.081.

 

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