Cardiogenic shock (CS) in a setting of aortic stenosis is associated with high mortality rates. In consequence, surgery is generally not a possibility for this patient group, and they usually undergo aortic valvuloplasty, resulting in a mortality rate of 33%-50% at 30 days, 70% at one year, and 90% at two years. While transcatheter aortic...
Severe aortic regurgitation (AR) may account for 20% to 30% of all surgical aortic valve replacements (SAVR) and is often associated with aortic stenosis (AS). Transcatheter treatment of these patients is limited due to anatomical factors such as root and annular dilation, large annular dimensions, and less calcification in the valve leaflets to serve as...
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...
Bicuspid aortic valve (BAV) stenosis is the most common congenital valve disease, affecting up to 2% of the population. Patients with BAV disease undergoing transcatheter aortic valve replacement (TAVR) account for 0.5%. In this context, TAVR data on BAV stenosis patients has been limited to observational studies on first generation valves that had resulted in...
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...
Impact of Aortic Valve Intervention on Coronary Flow Reserve Myocardial flow might be compromised in patients with severe aortic stenosis, which might be driven by CAD and concomitant atherosclerosis or a compromised capillary bed. Capillary circulation might be compromised by increased left ventricular mass (LVM) which in turn might alter coronary flow reserve (CFR). Multiple...
Patients with severe symptomatic aortic stenosis treated with aortic valve replacement might still present cardiac failure, even after successful procedures. According to some reports, the incidence of cardiac failure after TAVR varies between 9% and 24%. The prognostic relevance of rehospitalization in these patients has not been studied yet; in fact, it remains unclear whether...
Though the different percutaneous valves have been designed and authorized for aortic stenosis with tricuspid valve, they have often been used to treat aortic regurgitation as an off-label indication. The Jenavalve Trilogy valve has recently received the CE Mark for aortic regurgitation and aortic stenosis. This study included 45 patients with severe AR. Primary end...
It is still unclear whether surgical aortic valve replacement (SAVR) is beneficial in asymptomatic patients with severe aortic stenosis (AS) and conserved left ventricular function (C1 indication according to AHA guidelines). The European American guidelines only recommend intervention in asymptomatic patient when there is ventricular compromise (ejection fraction <50%, class I indication) or with a...
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...