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Aortic stenosis guidelines

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https://www.readbyqxmd.com/read/27903539/outcome-implication-of-aortic-valve-area-normalized-to-body-size-in-asymptomatic-aortic-stenosis
#1
Christophe Tribouilloy, Yohann Bohbot, Sylvestre Maréchaux, Nicolas Debry, Quentin Delpierre, Marcel Peltier, Momar Diouf, Michel Slama, David Messika-Zeitoun, Dan Rusinaru
BACKGROUND: Current guidelines define severe aortic stenosis in patients with aortic valve area normalized to body surface area (AVA/BSA) <0.6 cm(2)/m(2); yet, this cutoff has never been validated. Moreover, it is not known whether AVA normalization to other body size indexes allows improved outcome prediction. We aim to test the value of AVA normalized to body size for outcome prediction in asymptomatic aortic stenosis. METHODS AND RESULTS: We included 289 patients with asymptomatic aortic stenosis, preserved ejection fraction, and AVA<1...
November 2016: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27887725/a-calcified-polymeric-valve-for-valve-in-valve-applications
#2
Ahmad Falahatpisheh, Daisuke Morisawa, Taraz T Toosky, Arash Kheradvar
The prevalence of aortic valve stenosis (AS) is increasing in the aging society. More recently, novel treatments and devices for AS, especially transcatheter aortic valve replacement (TAVR) have significantly changed the therapeutic approach to this disease. Research and development related to TAVR require testing these devices in the calcified heart valves that closely mimic a native calcific valve. However, no animal model of AS has yet been available. Alternatively, animals with normal aortic valve that are currently used for TAVR experiments do not closely replicate the aortic valve pathology required for proper testing of these devices...
November 16, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27875347/severe-low-gradient-aortic-stenosis-with-preserved-ventricular-function-should-it-be-treated
#3
Giuseppe Di Pasquale, Gloria Vassilikì Coutsoumbas, Silvia Zagnoni
Exists a group of patients with small AVA (<0,6 cm/m), and normal LVEF (≥50%) who display a low transvalvular flow (LF) [index stroke volume (SVi)<35 ml/m2] and/or low transvalvular gradient (LG). This condition is called severe paradoxical aortic stenosis (SAO) LFLG. In many studies this condition was associated to increased mortality both with medical therapy and with surgical intervention. Crucial is define correctly the diagnostical criteria of this condition. Indeed there are several specific anatomical and functional characteristics useful in differentiating paradoxical severe aortic stenosis from the other forms of aortic stenosis...
November 19, 2016: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/27867460/percutaneous-dual-valve-intervention-in-a-high-risk-patient-with-severe-aortic-and-mitral-stenosis
#4
Blaz Mrevlje, Mohamad Aboukura, Christoph A Nienaber
Aortic stenosis is the most frequent and mitral stenosis is the least frequent native single-sided valve disease in Europe. Patients with the combination of severe symptomatic degenerative aortic and mitral stenosis are very rare. Guidelines for the treatment of heart valve diseases are clear for single-valve situations. However, there is no common agreement or recommendation for the best treatment strategy in patients with multiple valve disease and severe concomitant comorbidities. A 76-year-old female patient with the combination of severe degenerative symptomatic aortic and mitral stenosis and several comorbidities including severe obesity, who was found unsuitable surgical candidate by the heart team and unsuitable for two-time general anesthesia in the case of two-step single-valve percutaneous approach by anesthesiologists, underwent successful percutaneous dual-valve single-intervention (transcatheter aortic valve implantation and percutaneous mitral balloon commissurotomy)...
July 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/27865193/different-clinical-outcomes-in-patients-with-asymptomatic-severe-aortic-stenosis-according-to-the-stage-classification-does-the-aortic-valve-area-matter
#5
Takeshi Kitai, Tomohiko Taniguchi, Takeshi Morimoto, Toshiaki Toyota, Chisato Izumi, Shuichiro Kaji, Kitae Kim, Naritatsu Saito, Kazuya Nagao, Tsukasa Inada, Eri Minamino-Muta, Takao Kato, Moriaki Inoko, Katsuhisa Ishii, Tadaaki Koyama, Ryuzo Sakata, Yutaka Furukawa, Takeshi Kimura
BACKGROUND: The ACC/AHA guidelines introduced a new classification of severe aortic stenosis (AS) mainly based on maximum jet velocity (Vmax) and mean pressure gradient (mPG), but not on aortic valve area (AVA). However, prognostic value of this new classification has not yet been fully evaluated. METHODS AND RESULTS: We studied 1512 patients with asymptomatic severe AS enrolled in the CURRENT AS registry in whom surgery was not initially planned. Patients were divided into 2 groups: Group 1 (N=122) comprised patients who met the recommendation for surgery; high-gradient (HG)-AS (Vmax≥4...
November 11, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27847162/patient-specific-computational-fluid-dynamics-assessment-of-aortic-hemodynamics-in-a-spectrum-of-aortic-valve-pathologies
#6
Pouya Youssefi, Alberto Gomez, Taigang He, Lisa Anderson, Nick Bunce, Rajan Sharma, C Alberto Figueroa, Marjan Jahangiri
OBJECTIVES: The complexity of aortic disease is not fully exposed by aortic dimensions alone, and morbidity or mortality can occur before intervention thresholds are met. Patient-specific computational fluid dynamics (CFD) were used to assess the effect of different aortic valve morphologies on velocity profiles, flow patterns, helicity, wall shear stress (WSS), and oscillatory shear index (OSI) in the thoracic aorta. METHODS: A total of 45 subjects were divided into 5 groups: volunteers, aortic regurgitation-tricuspid aortic valve (AR-TAV), aortic stenosis-tricuspid aortic valve (AS-TAV), aortic stenosis-bicuspid aortic valve right-left cusp fusion (BAV[RL]), and aortic stenosis-right-non cusp fusion (AS-BAV[RN])...
September 23, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27776799/relation-between-clinical-best-practices-and-6-month-outcomes-after-transcatheter-aortic-valve-implantation-with-corevalve-from-the-advance-ii-study
#7
Jan-Malte Sinning, Anna Sonia Petronio, Nicolas Van Mieghem, Giulio Zucchelli, Georg Nickenig, Raffi Bekeredjian, Johan Bosmans, Francesco Bedogni, Marian Branny, Karl Stangl, Jan Kovac, Anna Nordell, Molly Schiltgen, Nicolo Piazza, Peter de Jaegere
Best practices for transcatheter aortic valve implantation with CoreValve include patient screening and valve size selection using multislice computed tomography, adherence to manufacturer recommendations for oversizing, control of implant depth to 6 mm or less, and management of conduction disturbances according to international guidelines. The ADVANCE II study implemented these strategies and demonstrated their relation to clinical outcomes. From October 2011 to April 2013, 200 patients with severe aortic stenosis were enrolled, and 194 were implanted...
September 30, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27773728/clinical-presentation-management-follow-up-and-outcomes-of-isolated-celiac-and-superior-mesenteric-artery-dissections
#8
Sara L Zettervall, Eleonora G Karthaus, Peter A Soden, Dominique B Buck, Klaas H J Ultee, Marc L Schermerhorn, Mark C Wyers
OBJECTIVE: Isolated visceral artery dissections are rare entities with no current consensus guidelines for treatment and follow-up. This study aims to evaluate the presentation, management, outcomes, and follow-up practices for patients with isolated visceral artery dissections and to compare those with and without symptoms. METHODS: In this retrospective analysis, we identified all patients with isolated celiac artery and/or isolated superior mesenteric artery dissections at a single institution between September 2006 and December 2014...
October 20, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27761871/the-crucial-role-of-cardiac-imaging-in-transcatheter-aortic-valve-replacement-tavr-pre-and-post-procedural-assessment
#9
Saif Al-Najafi, Frank Sanchez, Stamatios Lerakis
Transcatheter valve interventions have emerged as one of the most important developments in structural heart disease over the past 20 years. Initially, these interventions were directed at patients with severe aortic stenosis and high surgical risk; however, their applications have extended to involve other native valves' pathologies, degenerated prosthetic valves, as well as patients of lower surgical risk. In this article, we discuss the importance of cardiac imaging in transcatheter aortic valve replacement (TAVR) by exploring the current practices, guidelines, and recommendations with the supporting data...
December 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27761705/emerging-therapeutic-options-for-lowering-of-lipoprotein-a-implications-for-prevention-of-cardiovascular-disease
#10
Michael B Boffa
PURPOSE OF REVIEW: Elevated plasma concentrations of lipoprotein(a) (Lp(a)) are an independent and causal risk factor for cardiovascular diseases including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis. This review summarizes the rationale for Lp(a) lowering and surveys relevant clinical trial data using a variety of agents capable of lowering Lp(a). RECENT FINDINGS: Contemporary guidelines and recommendations outline populations of patients who should be screened for elevated Lp(a) and who might benefit from Lp(a) lowering...
December 2016: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/27753861/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#11
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27687903/patient-values-and-preferences-on-transcatheter-or-surgical-aortic-valve-replacement-therapy-for-aortic-stenosis-a-systematic-review
#12
Lyubov Lytvyn, Gordon H Guyatt, Veena Manja, Reed A Siemieniuk, Yuan Zhang, Thomas Agoritsas, Per O Vandvik
OBJECTIVE: To investigate patients' values and preferences regarding aortic valve replacement therapy for aortic stenosis. SETTING: Studies published after transcatheter aortic valve insertion (TAVI) became available (2002). PARTICIPANTS: Adults with aortic stenosis who are considering or have had valve replacement, either TAVI or via surgery (surgical aortic valve replacement, SAVR). OUTCOME MEASURES: We sought quantitative measurements, or qualitative descriptions, of values and preferences...
2016: BMJ Open
https://www.readbyqxmd.com/read/27683246/transcatheter-versus-surgical-aortic-valve-replacement-in-patients-with-severe-aortic-stenosis-at-low-and-intermediate-risk-systematic-review-and-meta-analysis
#13
Reed A Siemieniuk, Thomas Agoritsas, Veena Manja, Tahira Devji, Yaping Chang, Malgorzata M Bala, Lehana Thabane, Gordon H Guyatt
OBJECTIVE:  To examine the effect of transcatheter aortic valve implantation (TAVI) versus surgical replacement of an aortic valve (SAVR) in patients with severe aortic stenosis at low and intermediate risk of perioperative death. DESIGN:  Systematic review and meta-analysis DATA SOURCES:  Medline, Embase, and Cochrane CENTRAL. STUDY SELECTION:  Randomized trials of TAVI compared with SAVR in patients with a mean perioperative risk of death <8%...
September 28, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27680583/transcatheter-or-surgical-aortic-valve-replacement-for-patients-with-severe-symptomatic-aortic-stenosis-at-low-to-intermediate-surgical-risk-a-clinical-practice-guideline
#14
Per O Vandvik, Catherine M Otto, Reed A Siemieniuk, Rodrigo Bagur, Gordon H Guyatt, Lyubov Lytvyn, Richard Whitlock, Trond Vartdal, David Brieger, Bert Aertgeerts, Susanna Price, Farid Foroutan, Michael Shapiro, Ray Mertz, Frederick A Spencer
No abstract text is available yet for this article.
September 28, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27659098/prevalence-of-elevated-lp-a-mass-levels-and-patient-thresholds-in-532%C3%A2-359-patients-in-the-united-states
#15
Steve Varvel, Joseph P McConnell, Sotirios Tsimikas
OBJECTIVE: Elevated lipoprotein(a) [Lp(a)] is a causal, independent risk factor for cardiovascular disease and aortic stenosis. We aimed to define the prevalence and patient thresholds of elevated Lp(a) levels in the United States. APPROACH AND RESULTS: We analyzed Lp(a) levels in 532 359 subjects from 2 data sets: (1) in 531 144 subjects from a referral laboratory and (2) in 915 patients from a tertiary referral center. Lp(a) mass levels were measured by immunoturbidometric assays in both centers and expressed as mg/dL...
September 22, 2016: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/27643098/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#16
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27594276/statins-for-aortic-valve-stenosis
#17
Luciana Thiago, Selma Rumiko Tsuji, Jonathan Nyong, Maria Es Puga, Aecio Ft Gois, Cristiane R Macedo, Orsine Valente, Álvaro N Atallah
BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus...
September 5, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27550231/bicuspid-aortic-valve-a-review-with-recommendations-for-genetic-counseling
#18
REVIEW
Samantha L Freeze, Benjamin J Landis, Stephanie M Ware, Benjamin M Helm
Bicuspid aortic valve (BAV) is the most common congenital heart defect and falls in the spectrum of left-sided heart defects, also known as left ventricular outflow tract obstructive (LVOTO) defects. BAV is often identified in otherwise healthy, asymptomatic individuals, but it is associated with serious long term health risks including progressive aortic valve disease (stenosis or regurgitation) and thoracic aortic aneurysm and dissection. BAV and other LVOTO defects have high heritability. Although recommendations for cardiac screening of BAV in at-risk relatives exist, there are no standard guidelines for providing genetic counseling to patients and families with BAV...
December 2016: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/27544900/integration-of-flow-gradient-patterns-into%C3%A2-clinical-decision-making-for-patients-with-suspected-severe-aortic-stenosis-and-preserved-lvef-a-systematic-review-of-evidence-and-meta-analysis
#19
Chirag Bavishi, Kiruthika Balasundaram, Edgar Argulian
OBJECTIVES: This study was designed to evaluate the evidence base for the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for severe aortic stenosis (SAS) and preserved left ventricular ejection fraction by comparing the natural history of the disease in subgroups of low-gradient (LG) aortic stenosis patients with high-gradient (HG) patients. BACKGROUND: The 2014 AHA/ACC valvular disease guidelines recommend estimation of stroke volume index by echocardiography in patients with suspected LG SAS and preserved left ventricular ejection fraction...
November 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27541718/the-use-of-standard-gastrointestinal-endoscopic-ultrasound-to-assess-cardiac-anatomy
#20
Kinza Sentissi, Mandeep S Sawhney, Douglas Pleskow, Paul Sepe, Jose M Mella, Benjamin Kwittken, Gyanprakash Ketwaroo, Balachundhar Subramaniam
In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist...
September 2016: Anesthesia and Analgesia
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