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Aortic stenosis guidelines

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https://www.readbyqxmd.com/read/28943483/permanent-decline-of-renal-function-after-infrarenal-abdominal-aortic-aneurysm-repair-frequency-and-risk-factors
#1
Liesa Zabrocki, Frank Marquardt, Klaus Albrecht, Andreas Kribben, Stefan Herget-Rosenthal
BACKGROUND: Permanent renal function decline, development and deterioration of chronic kidney disease (CKD) are associated with serious complications. How frequent is renal function decline after infrarenal abdominal aortic aneurysm (iAAA) repair according to current definitions and what are its risk factors, especially potentially modifiable ones? METHODS: Retrospective observational study including all patients with elective or urgent iAAA repair from 2007 to 2011...
September 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28910289/how-tavi-registries-report-clinical-outcomes-a-systematic-review-of-endpoints-based-on-varc-2-definitions
#2
Shixuan Zhang, Peter L Kolominsky-Rabas
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has been demonstrated to be an alternative treatment for severe aortic stenosis in patients considered as high surgical risk. Since its first human implantation by Cribier et al., TAVI has been shown to increase survival rate and quality of life for high surgical risks patients. The objective of this study is to provide an overview of TAVI registries and the reporting clinical outcomes based on the VARC-2 definitions. In addition, the comparability and adherence of VARC-2 reporting within the identified TAVI registries was reviewed...
2017: PloS One
https://www.readbyqxmd.com/read/28877303/association-of-guideline-adherence-for-serial-evaluations-with-survival-and-adverse-clinical-events-in-patients-with-asymptomatic-severe-aortic-stenosis
#3
Aisha Ahmed, Paul Sorajja, Ross F Garberich, R Saeid Farivar, Kevin M Harris, Mario Gössl
Importance: For patients with asymptomatic severe aortic stenosis and normal left ventricular function, current practice guidelines empirically recommend serial evaluations every 6 to 12 months. The benefit of this clinical monitoring is unknown. Objective: To determine the association of guideline adherence with clinical outcomes in patients with asymptomatic severe aortic stenosis. Design, Setting, and Participants: This retrospective cohort study involved 300 patients with asymptomatic severe aortic stenosis who were seen in the ambulatory Minneapolis Heart Institute at Abbott Northwestern Hospital...
September 6, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28872094/-transcatheter-aortic-valve-implantation-present-and-development-trend
#4
Yi He, Haiting Zhou, Shuqiang Zhu, Yongbing Wu
Currently, although surgical aortic valve replacement (SAVR) is still the golden standard in treatment of severe aortic stenosis according to the guideline, transcatheter aortic valve implantation (TAVI) is gradually becoming a common treatment for patients who are prohibitive or in high risk for SAVR. Recently, the valve manufacturers, including medical companies in China, are making their utmost to develop valve device, leading remarkable results achieved by TAVI. With the complications being controlled, TAVI displays promising future...
August 28, 2017: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/28856517/bicuspid-aortic-valve-related-aortopathy
#5
REVIEW
Sina Stock, Salah A Mohamed, Hans-Hinrich Sievers
Bicuspid aortic valve related aortopathy is known to significantly increase the risk for catastrophic aortic events and, therefore, represents a considerable health burden. Albeit of ongoing research in this field including genetic, molecular, hemodynamic and morphologic aspects, bicuspid aortic valve related aortopathy still represents an imperfectly understood disorder. This lack in knowledge results in a lack of consistency considering different therapeutic approaches. Recent studies have provided new insights into the etiology and clinical impacts of bicuspid aortic valve related aortopathy in different clinical settings, leading to a growing body of opinion towards a more individualized surgical approach than currently provided by the guidelines...
August 30, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28827255/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
#6
Kjersti Oterhals, Rune Haaverstad, Jan Erik Nordrehaug, Geir Egil Eide, Tone M Norekvål
OBJECTIVES: To investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes. DESIGN: A cross-sectional survey with an 18-month follow-up. SETTING: One tertiary university hospital in Western Norway. PARTICIPANTS: In all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study...
August 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28814490/clinical-features-and-prognosis-of-patients-with-isolated-severe-aortic-stenosis-and-valve-area-less-than-1-0-cm-2
#7
Praveen Mehrotra, Katrijn Jansen, Timothy C Tan, Aidan Flynn, Judy W Hung
OBJECTIVE: Current guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm(2), but some authors have suggested that the AVA cut-off be decreased to 0.8 cm(2). 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 cm(2). METHODS: Patients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8-0.99 cm(2) (n=105) were compared with those with an AVA<0...
August 16, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28780662/bicuspid-aortic-valvulopathy-and-associated-aortopathy-a-review-of-contemporary-studies-relevant-to-clinical-decision-making
#8
REVIEW
Michael H Kwon, Thoralf M Sundt
The bicuspid aortic valve (BAV) phenotype is becoming increasingly recognized as a complex and heterogeneous clinical entity, with some but not all patients developing accelerated degrees of both aortic insufficiency (AI) and aortic stenosis (AS) in comparison to patients with tricuspid aortic valves (TAV). In addition, there remains a well-established association between the BAV phenotype and aortic enlargement independent of valve function as well as progression among some to ascending aortic aneurysm and the attendant concern over risk of aortic dissection...
September 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28759471/the-ross-procedure-in-adults-which-patients-which-disease
#9
Amine Mazine, Ismail El-Hamamsy, Maral Ouzounian
PURPOSE OF REVIEW: The purpose of this article is to review the contemporary evidence surrounding the use of the Ross procedure in young and middle-aged adults and to identify the subset patients who are most likely to derive a benefit from this operation. RECENT FINDINGS: In appropriately selected young and middle-aged adults undergoing aortic valve replacement (AVR), the Ross procedure is currently the only operation that can restore long-term survival that is equivalent to that of the age-matched healthy general population...
July 29, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28687561/impact-of-vascular-hemodynamics-on-aortic-stenosis-evaluation-new-insights-into-the-pathophysiology-of-normal-flow-small-aortic-valve-area-low-gradient-pattern
#10
Nancy Côté, Louis Simard, Anne-Sophie Zenses, Lionel Tastet, Mylène Shen, Marine Clisson, Marie-Annick Clavel
BACKGROUND: About 50% of normal-flow/low-gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements...
July 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28671804/valvular-heart-disease-in-adults-etiologies-classification-and-diagnosis
#11
REVIEW
Steven M Hollenberg
The prevalence of valvular heart disease (VHD) in the United States was estimated to be approximately 2.5% in the 1990s. The prevalence currently is thought to be increasing because of more accurate diagnostic methods and aging of the population. Mitral regurgitation (MR) is the most common valve defect, followed by aortic stenosis (AS) and aortic regurgitation (AR). Degenerative disease is the most common etiology of MR, AS, and AR, though these forms of VHD also can be caused by congenital valve defects, systemic inflammatory diseases, endocarditis, and many other conditions...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28640443/pathophysiology-of-aortic-stenosis-and-mitral-regurgitation
#12
Gianluca L Perrucci, Marco Zanobini, Paola Gripari, Paola Songia, Bayan Alshaikh, Elena Tremoli, Paolo Poggio
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR)...
June 18, 2017: Comprehensive Physiology
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#13
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28593422/treatment-of-asymptomatic-aortic-valve-stenosis-watchful-waiting-or-early-intervention
#14
J Ledwoch, H Thiele
There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for the majority of asymptomatic patients. However, data on the prognosis of asymptomatic AS are inconsistent. Some reports claim an increased risk of complications and even mortality in this subset of patients when treated conservatively. Several factors are considered to contribute to the impaired outcome of asymptomatic patients, such as progressive myocardial damage or sudden cardiac death, during the watchful waiting period...
June 7, 2017: Herz
https://www.readbyqxmd.com/read/28572283/impact-of-mean-transaortic-pressure-gradient-on-long-term-outcome-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction
#15
Yohann Bohbot, Cedric Kowalski, Dan Rusinaru, Anne Ringle, Sylvestre Marechaux, Christophe Tribouilloy
BACKGROUND: Mean transaortic pressure gradient (MTPG) has never been validated as a predictor of mortality in patients with severe aortic stenosis. We sought to determine the value of MTPG to predict mortality in a large prospective cohort of severe aortic stenosis patients with preserved left ventricular ejection fraction and to investigate the cutoff of 60 mm Hg, proposed in American guidelines. METHODS AND RESULTS: A total of 1143 patients with severe aortic stenosis defined by aortic valve area ≤1 cm(2) and MTPG ≥40 mm Hg were included...
June 1, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28560534/exercise-testing-and-stress-imaging-in-aortic-valve-disease
#16
REVIEW
Luc A Pierard, Raluca Dulgheru
Aortic valve disease and especially aortic stenosis (AS) is a growing cardiac pathology. Aortic valve replacement (AVR) is still the only treatment with proven benefit on survival in symptomatic patients and in patients with a left ventricular ejection fraction (LVEF) <50%. The benefit of prophylactic AVR in asymptomatic patients is still unproven. Once symptoms develop, the prognosis worsens. Exercise testing has emerged as a tool to unmask the "pseudo-asymptomatic" patients with AS (those without self-reporting symptoms), to link "exercise induced dyspnea" more confidently and more objectively to aortic valve disease and to allow for a safe "watchful waiting strategy" in "pseudo-symptomatic" patients (those with dyspnea unrelated to aortic valve disease)...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28550588/value-of-ct-signs-and-measurements-as-a-predictor-of-pulmonary-hypertension-and-mortality-in-symptomatic-severe-aortic-valve-stenosis
#17
Matthias Eberhard, Monika Mastalerz, Jovana Pavicevic, Thomas Frauenfelder, Fabian Nietlispach, Francesco Maisano, Felix C Tanner, Thi Dan Linh Nguyen-Kim
To assess the value of computed tomography (CT) for non-invasive detection of pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and to correlate CT measurements and signs with mortality after TAVI. 257 TAVI patients (median 84 years; 134 females) with both right heart catheterisation (RHC) and CT within 3 days were retrospectively analyzed. According to guidelines PH was defined as mean pulmonary artery pressure ≥25 mmHg in RHC. CT-signs for PH assessment were evaluated...
May 26, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28507251/stress-testing-in-asymptomatic-aortic-stenosis
#18
REVIEW
Björn Redfors, Philippe Pibarot, Linda D Gillam, Daniel Burkhoff, Jeroen J Bax, Brian R Lindman, Robert O Bonow, Patrick T O'Gara, Martin B Leon, Philippe Généreux
Aortic stenosis is 1 of the most common heart valve diseases among adults. When symptoms develop, prognosis is poor, and current guidelines recommend prompt aortic valve replacement. Depending of the severity of the aortic stenosis and the presence of concomitant heart disease and medical comorbidities, stress testing represents a reasonable strategy to help better risk stratify asymptomatic patients. The present report provides a comprehensive review of the current available data on stress testing in aortic stenosis and subsequently summarizes its potential for guiding the optimal timing of aortic valve replacement...
May 16, 2017: Circulation
https://www.readbyqxmd.com/read/28465975/review-in-translational-cardiology-micrornas-and-myocardial-fibrosis-in-aortic-valve-stenosis-a-deep-insight-on-left-ventricular-remodeling
#19
REVIEW
Fabiani Iacopo, Conte Lorenzo, Enrico Calogero, Passiatore Matteo, Pugliese Nicola Riccardo, Santini Veronica, Barletta Valentina, Liga Riccardo, Scatena Cristian, Mazzanti Chiara Maria, Di Bello Vitantonio
MicroRNAs (miRNAs) are a huge class of noncoding RNAs that regulate protein-encoding genes (degradation/inhibition of translation). miRNAs are nowadays recognized as regulators of biological processes underneath cardiovascular disorders including hypertrophy, ischemia, arrhythmias, and valvular disease. In particular, circulating miRNAs are promising biomarkers of pathology. This review gives an overview of studies in aortic valve stenosis (AS), exclusively considering myocardial remodeling processes. We searched through literature (till September 2016), all studies and reviews involving miRNAs and AS (myocardial compartment)...
October 2016: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/28462903/long-term-outcomes-after-tavi-in-patients-with-different-types-of-aortic-stenosis-the-conundrum-of-low-flow-low-gradient-and-low-ejection-fraction
#20
Miriam Puls, Kerstin Pia Korte, Annalen Bleckmann, Mark Huenlich, Bernhard C Danner, Friedrich Schoendube, Gerd Hasenfuß, Claudius Jacobshagen, Wolfgang Schillinger
AIMS: The objective of this study was to examine the impact of guideline-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS: Four hundred (400) consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (for up to seven years). One hundred and forty-seven (147) individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40 mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index [SVI] <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient)...
June 20, 2017: EuroIntervention
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