scholarly journals Outcomes in asymptomatic, severe aortic stenosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249610
Author(s):  
Anette Borger Kvaslerud ◽  
Kenan Santic ◽  
Amjad Iqbal Hussain ◽  
Andreas Auensen ◽  
Arnt Fiane ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Asymptomatic Patients ◽  
History Of ◽  
Artery Disease

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.

scholarly journals Coronary Artery Disease and Outcomes of Aortic Valve Replacement for Severe Aortic Stenosis

2013 ◽  
Vol 61 (8) ◽  
pp. 837-848 ◽  
Author(s):  
Jocelyn M. Beach ◽  
Tomislav Mihaljevic ◽  
Lars G. Svensson ◽  
Jeevanantham Rajeswaran ◽  
Thomas Marwick ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Artery Disease

scholarly journals Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Heart ◽  
2020 ◽  
Vol 106 (11) ◽  
pp. 802-809 ◽  
Author(s):  
Tomohiko Taniguchi ◽  
Takeshi Morimoto ◽  
Yasuaki Takeji ◽  
Takao Kato ◽  
Takeshi Kimura
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Medical Treatment ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Conservative Strategy ◽  
Asymptomatic Patients

Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry was a large Japanese multicentre retrospective registry of consecutive patients with severe aortic stenosis (AS) before introduction of transcatheter aortic valve implantation. We sought to overview the data from the CURRENT AS registry to discuss the three major contemporary issues related to clinical practice in patients with severe AS: (1) under-referral/underuse of surgical aortic valve replacement (SAVR) in symptomatic patients with severe AS, (2) management of asymptomatic patients with severe AS and (3) management of patients with low-gradient severe aortic stenosis (LG-AS). First, despite the dismal prognosis of symptomatic patients with severe AS, SAVR, including those performed during follow-up, was reported to be underused. In the CURRENT AS registry, overall 53% of symptomatic patients underwent aortic valve replacement (AVR) during follow-up. Second, we reported that compared with conservative strategy, initial AVR strategy was associated with lower risk of all-cause death and heart failure hospitalisation in asymptomatic patients with severe AS. Although current recommendations for AVR are mainly dependent on the patient symptoms, some patients may not complain of any symptom because of their sedentary lifestyle. We also reported several important objective factors associated with worse clinical outcomes in asymptomatic patients with severe AS for risk stratification. Finally, initial AVR strategy was associated with better long-term clinical outcomes than conservative strategy in both patients with high-gradient AS and patients with LG-AS. The favourable effect of initial AVR strategy was also seen in patients with LG-AS with left ventricular ejection fraction of ≥50%.

Percutaneous Coronary Intervention following Placement of Sutureless Aortic Bioprostheses

2019 ◽  
Vol 14 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Kiran Kaur ◽  
Miryea Cisneros ◽  
Sandeep Nathan ◽  
John E.A. Blair ◽  
Husam H. Balkhy
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease is often present with aortic stenosis. Although transcatheter aortic valve replacement and minimally invasive surgery provide alternative sternal-sparing options for isolated aortic valve replacement, non-sternotomy treatment of combined coronary artery disease and aortic stenosis has not been well-defined. We report 3 patients who presented with severe aortic stenosis and obstructive coronary artery disease in whom minimally invasive aortic valve replacement using sutureless valve was performed, followed by transradial percutaneous coronary intervention of obstructive coronary lesion. This case series demonstrates a hybrid technique for the treatment of combined severe aortic stenosis and coronary artery disease, which has potential for adequately treating both conditions with minimal risk.

scholarly journals Timing of Intervention in Asymptomatic Patients with Aortic Stenosis

2021 ◽  
Vol 16 ◽  
Author(s):  
Teresa Sevilla ◽  
Ana Revilla-Orodea ◽  
J Alberto San Román
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Perioperative Complications ◽  
Scientific Evidence ◽  
Optimal Timing ◽  
Common Disease ◽  
Asymptomatic Patients

Aortic stenosis is a very common disease. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Continuous advances in both surgical and percutaneous techniques have substantially decreased rates of perioperative complications and mortality; with this in mind, many authors suggest that earlier intervention in patients with severe aortic stenosis, when they are still asymptomatic, may be indicated. This paper summarises what is known about the natural history of severe aortic stenosis and the scientific evidence available about the optimal timing for aortic valve replacement.

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