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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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Cardiac imaging in AS - cardiac damage
 

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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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Cardiac imaging in AS - coronary access
 

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TAVI Summit - Live case from Berlin

Live case from Berlin on refining TAVI
 

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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
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  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.
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  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.
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  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.
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  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.
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