Aortic Valve Replacement: Are We Spoiled for Choice?

Bashir, Mohamad; Harky, Amer; Bleetman, David; Adams, Benjamin; Roberts, Neil; Balmforth, Damian; Yap, John; Lall, Kulvinder; Shipolini, Alex; Oo, Aung; Uppal, Rakesh

doi:10.1053/j.semtcvs.2017.08.003

Cited by 18 publications

(14 citation statements)

References 46 publications

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“…In light of the recently published data regarding the outcomes of TAVI, especially in those with a high‐risk surgical profile, debate regarding the most appropriate intervention to treat patients with severe aortic stenosis across all surgical profiles has arisen . Although the current consensus recommends TAVI only in patients who meet the indications for AVR (Table ) but deemed “inoperable,” Siontis et al have observed that there is a significant relative risk reduction of 2‐year mortality in high‐risk patients with symptomatic, severe aortic stenosis undergoing TAVI compared with SAVR …”

Section: Savr In Patients With Aortic Stenosis?mentioning

confidence: 99%

TAVI and the future of aortic valve replacement

et al. 2019

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Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints. K E Y W O R D S aortic valve, surgery, TAVI, valve replacement 1 | INTRODUCTION Aortic valve stenosis (AS) is the most common valvular pathology, with between 2% and 4% of patients over the age of 75 years bring affected. 1 For decades, surgical aortic valve replacement (SAVR) has been considered the class I recommendation in the management of AS. 2 However, given that advanced age, frailty, and significant comorbidities are increasingly prevalent in affected patients; more than one-third of high-risk and severe symptomatic AS patients were not considered physiologically fit enough for major surgical intervention. 2,3 This merited the development of TAVI, an intervention suitable for high-risk patients and those deemed unfit for surgery. With a shift in clinical paradigm toward minimally invasive procedures, the development of TAVI has revolutionized clinical outcomes in AS, particularly in those once considered inoperable. 4 The decision to use TAVI vs SAVR for aortic valve replacement (AVR) is determined by clinical, anatomical, and technical considerations. Since its introduction in 2002, 5 TAVI has increasingly replaced SAVR, the once considered gold standard treatment, in aortic valve diseases. 6-10 More recently, trials such as the Placement of Aortic Trans-Catheter Valve II (PARTNER II) and Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) 11,12 have further established the use of TAVI in intermediate-risk patients as well. Given this validation of TAVI within high-and intermediate-risk patients, a need has now developed to evaluate the clinical efficacy of TAVI within low-risk surgical candidates. 13Selective candidate criteria, as well as advances in operative techniques within TAVI, are mainstay contributors to successful outcomes. Fundamentally, there exist both retrogr...

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Section: Savr In Patients With Aortic Stenosis?mentioning

confidence: 99%

TAVI and the future of aortic valve replacement

et al. 2019

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“…There should be further studies to understand the choice of valve types and approaches treating aortic diseases in this cohort of patients. [53][54][55][56][57] The importance of pre-pregnancy counseling is well recognized and should be offered to all women with cardiac conditions.…”

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Pregnancy and cardiac interventions: What are the optimal management options?

et al. 2020

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Cardiac disease is the leading cause of maternal mortality in the United Kingdom. Major causes of cardiac death in pregnant women include cardiomyopathies, myocardial infarction, ischemic heart disease, and aortic dissection. Uncorrected congenital heart disease and women who have had corrective or palliative surgery may have complicated pregnancies as well. Some women with significant cardiac disease are unable to meet the increased physiological demands of pregnancy. Of these, those who do not respond to medical treatment may require surgical correction such as coronary artery bypass grafting. The risk of cardiac operations for pregnant women is similar to that for nonpregnant women but the fetal mortality rate remains high. Contributing factors to high fetal mortality rates include timing, urgency of operation, and the fetal/fetoplacental response to cardiopulmonary bypass. The aim of this review is to summarize current evidence in utilizing the different management approaches of cardiac issues during pregnancy.

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“…Of this aortic valve subgroup, all the mothers survived, with one Fetal death was reported (Fetal mortality 12.5% in the subgroup). Despite this limited level of evidence, it is clear that open valve replacement requiring CPB represents a significant risk to both mother and Fetus, and thus should be considered very carefully and in selected lifesaving cases only . A summary of the studies examining pregnant patients undergoing open heart surgery used in this review can be found in Table .…”

Section: Surgery During Pregnancymentioning

confidence: 99%

“…Summary of percutaneous balloon aortic valvuloplasty case reports Summary of studies examining aortic valve type impact on pregnancy outcomes AVR, aortic valve replacement; AR, aortic regurgitation; AS, aortic stenosis, bio., bioprosthetic; mech., mechanical; MVR, mitral valve replacement; VTE, venous thromboembolism.Despite this limited level of evidence, it is clear that open valve replacement requiring CPB represents a significant risk to both mother and Fetus, and thus should be considered very carefully and in selected lifesaving cases only [59][60][61]. A summary of the studies examining pregnant patients undergoing open heart surgery used in this review can be found inTable 7.13 | IS TAVI THE FUTURE FOR AORTIC STENOSIS DURING PREGNANCY?…”

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Management of aortic valve disease during pregnancy: A review

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Cardiovascular disease represents a significant portion of pregnancy‐related complications and is associated with high rates of morbidity and mortality in this cohort. Cardiac valvulopathy, and aortic valve pathologies, in particular, pose a significant challenge to women who are pregnant and to the health care professionals who look after them. Depending on the type and severity of aortic valve pathology, pregnancy may exacerbate or accelerate the progression of valvulopathy sequelae because of the hemodynamic changes that occur from conception, throughout gestation, up to Labor and postpartum. Management of such patients ranges from basic conservative measures such as bed‐rest, extending to high‐risk emergency open heart surgery. This nonstructured review aims to highlight the current evidence available relating to the management of aortic valve disease in pregnancy, with a key focus on cases which requires intervention beyond that of medical therapy. In conclusion, the management of aortic valvulopathy in pregnancy is a challenging field with only a small amount of clinical experience and retrospective study supporting evidence‐based decisions in this field. A greater understanding of the most recent advances is recommended to support decision making in this specialist field of clinical medicine.

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Aortic Valve Replacement: Are We Spoiled for Choice?

Cited by 18 publications

References 46 publications

TAVI and the future of aortic valve replacement

TAVI and the future of aortic valve replacement

Pregnancy and cardiac interventions: What are the optimal management options?

Management of aortic valve disease during pregnancy: A review

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