scholarly journals Asymptomatic Patients with Severe Aortic Stenosis and the Impact of Intervention

2021 ◽  
Vol 8 (4) ◽  
pp. 35
Author(s):  
Mevlüt Çelik ◽  
Milan Milojevic ◽  
Andras P. Durko ◽  
Frans B. S. Oei ◽  
Edris A. F. Mahtab ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Survival Rates ◽  
Aortic Valve Area ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
History Of ◽  
The Impact

Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. Methods: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). Conclusions: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.

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.

Abstract 13454: The Impact of Prior Stroke on the Outcome of Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Romain Didier ◽  
Edward Koifman ◽  
Sarkis Kiramijyan ◽  
Smita Negi ◽  
Ricardo Escarcega ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Minor Stroke ◽  
Post Procedure ◽  
Cerebrovascular Events ◽  
History Of ◽  
The Impact ◽  
Prior Stroke

Introduction: Prior stroke has been identified as an independent correlate for post-procedure cerebrovascular events (CVE) in aortic stenosis (AS) patients undergoing surgical aortic valve replacement (SAVR). The present study aimed to evaluate the impact of prior cerebrovascular events on outcome in AS patients undergoing TAVR. Methods: Patients with severe AS undergoing TAVR between May 2007-March 2015 were included and categorized to patients with and without prior CVE defined as stroke and transit ischemic attack. Baseline, procedural characteristics, in-hospital outcomes, 1-month and 1-year mortality were compared, in accordance with the VARC-2 consensus. Results: A cohort of 662 consecutive patients with severe AS undergoing TAVR was included in the analysis. Of these, 120 patients had prior CVE, and 542 without. Balloon expandable valve was used in 70.7% and self-expandable valve in 29.3% of the patients. Trans-femoral access was used in 78% (571), and pre-TAVR balloon aortic valvuloplasty was performed in 87% (574). Patients with prior CVE had a higher mean STS score compared to those without prior CVE (10.1% versus 8.8%, respectively; p=0,006) and demonstrated higher rates of atherosclerotic disease involving the coronary, peripheral and carotid arteries. In-hospital minor stroke occurred more often in patients with prior CVE vs. those without CVE (3.3% vs. 0.7%; p=0.04). However, similar mortality rates were recorded at 1, 6, and 12 months (figure 1), and there were no significant differences in major stroke, bleeding, or post-procedure hospital stay between both groups. Conclusions: Prior history of CVE infers a higher risk for in-hospital minor stroke, yet no impact on other outcomes post TAVR. Patients with and without a history of prior CVE with severe aortic stenosis will similarly benefit from TAVR. Therefore, a history of CVE should not be considered an exclusion criterion.

scholarly journals Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Robert Zilberszac ◽  
Andreas Gleiss ◽  
Ronny Schweitzer ◽  
Piergiorgio Bruno ◽  
Martin Andreas ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Ventricular Dysfunction ◽  
Survival Rates ◽  
Right Ventricular Dysfunction ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Term Survival

Abstract Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm2 and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1–97.9%), 83.0% (CI 60.7–93.3%) and 56.3% (CI 32.1–74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2–93.1%), 52.9% (CI 33.7–69.0%) and 30.3% (CI 14.6–47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70–7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13–4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38–8.35]) and higher aortic jet velocity (HR 0.91[0.82–1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.

scholarly journals Life expectancy of patients undergoing surgical aortic valve replacement compared with that of the general population

2019 ◽  
Vol 30 (3) ◽  
pp. 394-399
Author(s):  
Daniel Hernandez-Vaquero ◽  
Rocio Diaz ◽  
Alberto Alperi ◽  
Marcel G Almendarez ◽  
Alain Escalera ◽  
...  
Keyword(s):  
Aortic Valve ◽  
General Population ◽  
Life Expectancy ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Survival Rates ◽  
Control Group ◽  
Surgical Aortic Valve Replacement ◽  
Term Survival

Abstract OBJECTIVES Surgical aortic valve replacement (SAVR) changes the natural history of severe aortic stenosis. However, whether the life expectancy of patients with severe aortic stenosis undergoing this surgical procedure is fully restored is unknown. The objective of this study was to assess if the life expectancy of patients aged &gt;75 years is fully restored after undergoing surgery for severe aortic stenosis. METHODS We compared long-term survival of a group of patients aged &gt;75 years, who underwent SAVR at our institution with the long-term survival of the general population. We matched each patient with 100 simulated individuals (control group) of the same age, sex and geographical region who died as indicated by the National Institute of Statistics. We compared survival curves and calculated hazard ratio (HR) or incidence rate ratio. Statistical significance existed if confidence intervals (CIs) did not overlap or did not include the value 1, as appropriate. RESULTS Average life expectancy of surgical patients who survived the postoperative period was 90.91 months (95% CI 82.99–97.22), compared to 92.94 months (95% CI 92.39–93.55) in the control group. One-, 5- and 8-year survival rates for SAVR patients who were discharged from the hospital were 94.9% (95% CI 92.74–96.43%), 71.66% (95% CI 67.37–75.5%) and 44.48% (95% CI 38.14–50.61%), respectively, compared to that of the general population: 95.8% (95% CI 95.64–95.95%), 70.64% (95% CI 70.28%–71%) and 47.91% (95% CI 47.52–48.31%), respectively (HR 1.07, 95% CI 0.94–1.22). CONCLUSION For patients over the age of 75 years who underwent SAVR and survived the postoperative period, life expectancy and survival rates were similar to that of the general population.

Abstract 4692: Impact of Pressure Recovery on Diagnosis of Severe Aortic Stenosis in Asymptomatic Patients. (A SEAS Substudy)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Edda Bahlmann ◽  
Dana Cramariuc ◽  
Eva Gerdts ◽  
Christa Gohlke-Baerwolf ◽  
Chritoph Nienaber ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Energy Loss ◽  
Severe Aortic Stenosis ◽  
Pressure Recovery ◽  
Doppler Velocity ◽  
Aortic Valve Area ◽  
Total Study Population ◽  
Asymptomatic Patients ◽  
Valve Area

Background: Downstream pressure recovery (PR) in the aorta affects transvalvular pressure gradient measurement and calculation of aortic valve area by continuity equation in patients with aortic stenosis (AS). Methods: To assess the clinical importance of PR on evaluation of severity of AS, echocardiographic data in 1562 patients with asymptomatic aortic stenosis (mean age 67 ± 10, 39% women, 51% hypertensive) recruited in the Simvastatin Ezitimibe in Aortic Stenosis (SEAS) study was used. The inner diameter of the ascending aorta was measured at annulus and at sinutubular junction. The aortic valve area (AVAI) was calculated from annular diameter and velocity time integrals from sub- and transaortic flow by Doppler. PR and PR corrected AVAI assessed as energy loss index (ELI) were calculated by previously published equations. Severe aortic stenosis was defined as AVAI <0.60cm 2 /m 2 and ELI <0.55cm 2 /m 2 , respectively. Patients were grouped into tertiles of peak transaortic Doppler velocity (<2.79, 2.79 –3.32, ≥3.33 m/sec, respectively). Results: In the total study population, PR ranged from 1.22–16.75 mmHg (mean 5.9±2.3), AVAI from 0.20 –1.85 cm 2 /m 2 (mean 0.67±0.22) and ELI from 0.22–5.94 cm 2 /m 2 (mean 0.89±0.45). PR increased significantly with severity of AS (Table 1 ). Both AVAI and ELI decreased with increasing peak transaortic velocity, and the overestimation of AS severity by using unadjusted AVA was largest in the lowest tertile (Table 1 ). Conclusion: Severity of AS is often overestimated in milder degrees of asymptomatic AS if correction for pressure recovery is not performed. Adjustment of AVA for the effect of energy loss should be performed routinely, and this may be especially important for accuracy of severity assessment in patients with relatively low transvalvular velocities. Table 1

Abstract 13349: Long Term (4 Years) Clinical and Echocardiographic Results of Transcatheter Self-expanding Medtronic Corevalve Device in Patients With Aortic Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vassilis Voudris ◽  
Sofia Thomopoulou ◽  
Manolis Vavuranakis ◽  
Maria Kariori ◽  
Christos Stefopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Self ◽  
Paravalvular Leak ◽  
Categorical Variables ◽  
Aortic Valve Area ◽  
Medtronic Corevalve

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients (pts) with severe aortic stenosis considered inoperable or at high operative risk. However, little is known about long-term outcomes following TAVI. In this study we assessed the 4-year clinical and echocardiographic outcomes of pts undergoing TAVI with the self expanding Medtronic CoreValve prosthesis. Methods: The 4-year outcomes following successful TAVI with the self-expanding aortic valve device (Medtronic CoreValve) were evaluated in 60 pts (mean age 79+6 years, male 47 %, Logistic Euroscore 28.43+10.93%). Principal outcome measures were death from any cause. An echocardiograpic examination was performed at prespecified intervals of 6 and 12 months, and every year afterwards. Categorical variables were compared using X2 test, and continuous variables using t test. Survival curves were also constructed. Results: All cause mortality at 1, 2, 3, and 4 years was 16.7%, 28.3%, 30%, and 40% respectively. Mean aortic valve gradient decreased from 50.96+18.6 mm Hg pre to 9.22+ 4.6 mm Hg after TAVI (P<0.001) and remained at 15.69+6.3 mm Hg at 4 years (p for post-TAVI trend <0.01). Mean aortic valve area increased from 0.66+ 0.14 cm2 pre to 1.87+0.33 cm2 after TAVI (p<0.001) and remained at 1.23+ 0.25 cm2 at 4 years (p for post-TAVI trend <0.01). Paravalvular leak (minimal to moderate) was observed in 61% of pts post-TAVI; however, there was no case of progression to severe regurgitation at 4 years follow-up. Conclusions: TAVI with the Medtronic CoreValve prosthesis is associated with sustained clinical and functional cardiovascular benefits in inoperable or high-risk patients with symptomatic aortic stenosis up to 4-year follow-up.

Clinical features and prognosis of patients with isolated severe aortic stenosis and valve area less than 1.0 cm2

Heart ◽  
2017 ◽  
Vol 104 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Praveen Mehrotra ◽  
Katrijn Jansen ◽  
Timothy C Tan ◽  
Aidan Flynn ◽  
Judy W Hung
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Features ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradients ◽  
Current Guidelines ◽  
Valve Area

ObjectiveCurrent guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm2, but some authors have suggested that the AVA cut-off be decreased to 0.8 cm2. The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8–0.99 cm2.MethodsPatients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8–0.99 cm2 (n=105) were compared with those with an AVA<0.8 cm2 (n=155) and 1.0–1.3 cm2 (n=81). The endpoint of this study was a combination of death from any cause or aortic valve replacement at or before 3 years.ResultsPatients with an AVA of 0.8–0.99 cm2 group comprised predominantly normal-flow, low-gradient (NFLG) AS, while high gradients and low flow were more often observed with an AVA<0.8 cm2. The frequency of symptoms was not significantly different between an AVA of 0.8–0.99 cm2 and 1.0–1.3 cm2. The combined endpoint was achieved in 71%, 52% and 21% of patients with an AVA of 0.8 cm2, 0.8–0.99 cm2and 1.0–1.3 cm2, respectively (p<0.001). Among patients with an AVA of 0.8–0.99 cm2, NFLG AS was associated with a lower hazard (HR=0.40, 95% CI 0.23 to 0.68, p=0.001) of achieving the combined endpoint with outcomes similar to moderate AS in the first 1.5 years of follow-up. Patients with high-gradient or low-flow AS with an AVA of 0.8–0.99 cm2 had outcomes similar to those with an AVA<0.8 cm2. The sensitivity for the combined endpoint was 61% for an AVA cut-off of 0.8 cm2 and 91% for a cut-off of 1.0 cm2.ConclusionsThe outcomes of patients with AS with an AVA of 0.8–0.99 cm2 are variable and are more precisely defined by flow-gradient status. Our findings support the current AVA cut-off of 1.0 cm2.

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%.

Prognostic Value of Aortic Valve Area Index in Asymptomatic Patients With Severe Aortic Stenosis

2012 ◽  
Vol 110 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Toshio Saito ◽  
Takashi Muro ◽  
Hisateru Takeda ◽  
Eiichi Hyodo ◽  
Shoichi Ehara ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Prognostic Value ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Area Index ◽  
Asymptomatic Patients ◽  
Valve Area

scholarly journals Aortic Stenosis in bicuspid and tricuspid aortic valves are two different scenarios

2021 ◽  
Author(s):  
Maria Celeste Carrero ◽  
Gerardo Masson ◽  
Ivan Constantin ◽  
Martin Ruano ◽  
Maria Mezzadra ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Significant Proportion ◽  
End Point ◽  
High Incidence ◽  
Baseline Characteristics ◽  
Level Institution ◽  
The Impact

Patients with bicuspid aortic valve (BAV) represent a significant proportion of adults with severe aortic stenosis (AS) requiring aortic valve intervention (AVI). Evidence is discordant concerning progression of AS in BAV. The aim of this study was to compare baseline characteristics and the impact of the aortic valve phenotype on major cardiovascular outcomes. Methods: Retrospective observational study (consecutive AS in database, 2014-2016, third-level institution). Baseline characteristics were compared between BAV (n = 43) and tricuspid (TAV) (n = 159) patients. Primary end point was a composite of mortality and AVI. Survival analysis and logistic regression analysis was used to identify predictors of primary end-point. Results: 202 patients (72.2 ± 13.4 years, 63% men) were included. Patients with TAV were older, had more comorbidities and less aorta dilation. No significant differences were observed in the primary end point between the two valve phenotypes (34.8 vs. 40.8%; p=0.47, follow-up of 3.2 ± 1.6 years). In BAV group most of the events were at the expense of AVI (32.5 vs. 13.8%; p=0.001). The incidence of CV death was similar between both groups (4.8% vs. 12%, p=0.25). Non-CV mortality was higher in TAV group (16.8% vs 0%, p=0.001). Vmax and dimensionless index were independently associated with primary end point (p<0.001). Conclusions: Patients with AS have a high incidence of all-cause mortality and aortic valve intervention, regardless of valve phenotype. In particular, patients with BAV present different clinical characteristics with lower overall mortality and a more advanced AS when requiring aortic valve intervention.

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