The presence of aortic stenosis, heart failure, and decreased ventricular function is associated with poor prognosis and high mortality. For this reason, both European and American guidelines classify severe stenosis as a Class I indication. There are two retrospective analyses that demonstrate the benefits of transcatheter aortic valve implantation (TAVI) via transfemoral access. The TAVR...
There is an important group of patients presenting low flow, low-gradient severe aortic stenosis (defined as mean gradient <40 mmHg). This is why we do dobutamine stress echocardiogram (DSE), to confirm whether we are dealing with truly severe aortic stenosis. However, it might not be well tolerated and a CT angiography will be done to...
Early surgical aortic valve replacement (SAVR) in patients with severe asymptomatic aortic stenosis can be beneficial in selected patients vs. waiting for symptoms. Severe AS in patients with no symptoms and conserved ventricular function raises few questions, clinically speaking. However, there is little evidence in favor of early intervention vs. close observation. The best data...
Amidst the current efforts to prove early intervention might have benefits in moderate aortic stenosis (AS), this trial comes along directing us back to basics. In patients with symptomatic aortic stenosis, peaking mortality will clearly justify intervention. But what is the case when there are no symptoms? According to this recent analysis published in JAMA,...
Asymptomatic aortic stenosis has been keeping us in tense stillness. However, there are new markers capable of identifying patients that might benefit from earlier intervention. In this regard, cardiovascular magnetic resonance (CMR) has been gaining its well-deserved place in cardiology and now more specifically in aortic stenosis. This study sought to validate CMR markers of...
Recent randomized trials including low-risk patients showed positive results for transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement. However, surgeons argue that these cases fail to consider patients from daily clinical practice, but rather include a population that has been carefully selected for randomized trials. Patients with non-tricuspid aortic stenosis, with severe...
Data from recent observational randomized studies suggest that most patients with asymptomatic severe aortic stenosis will eventually receive an indication for valve replacement. Mortality in this “asymptomatic” population is caused not only by sudden death, but also by cardiac death. Early intervention may prevent these deaths as a consequence of aortic stenosis symptoms. Researchers...
This meta-analysis tells us that patients with active malignancies and severe aortic stenosis have a good evolution after transcatheter aortic valve replacement (TAVR), except for a higher rate of pacemaker implantation in the general population. These patients must not be limited to respite care only, at least as far as aortic stenosis is concerned. Short-term...
Courtesy of Dr. Carlos Fava. Aortic valve calcification and its resulting stenosis leads to changes in left ventricle hemodynamics, producing diffuse ischemia followed by inflammation, increased extracellular matrix, necrosis, and later, diffuse fibrosis. At present, with magnetic resonance imaging (MRI) we can analyze ventricular architecture and its function by detecting fibrosis (LGE) and its volume...
This small randomized study heated the debate about when to intervene aortic stenosis (AS). Putting off surgical valve replacement (SAVR) in patients with asymptomatic AS and waiting for symptom onset with conservative care increased periprocedural risk and all cause cardiovascular death. This study presented by Dr Duk-Hyun Kang during AHA 2019 scientific sessions (simultaneously published...