Early valve replacement for aortic stenosis irrespective of symptoms results in better clinical survival: A meta-analysis of the current evidence

Zhao, Ying; Owen, Andrew; Henein, Michael

doi:10.1016/j.ijcard.2013.05.089

Cited by 9 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study in cancer patients with severe AS showed that AVR improves survival, which is independent of cancer status and the presence of metastases [8]. Associated malignancy, however, requires special attention in evaluation of the patient, as the disease itself may decrease exercise capacity and render the patient asymptomatic despite the presence of already severe aortic stenosis [14]. Typical symptoms of dyspnoea, dizziness and reduced exertional capacity develop slowly and can be confused for the progression of the malignant disease.…”

Section: Case Presentationmentioning

confidence: 99%

Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report

Mrak

Ambrožič

Mušič

et al. 2016

Wien Klin Wochenschr

View full text Add to dashboard Cite

Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.

show abstract

Section: Case Presentationmentioning

confidence: 99%

Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report

Mrak

Ambrožič

Mušič

et al. 2016

Wien Klin Wochenschr

View full text Add to dashboard Cite

show abstract

“…Longitudinal dyssynchrony is an important contributing mechanism in the progression of CHF and of LV remodeling [11]. LVH and fibrosis can lead to distorted electrical activation and hence impaired LV filling [45]. Non-uniformity in the damage of cardiomyocytes may lead to dyssynchrony and nonuniform regional LV dysfunction.…”

Section: The Functional Changes Of the LV Include Stiffness Pressurementioning

confidence: 99%

“…The increase in LA pressure is necessary for an adequate filling of the stiffer LV and points to a more advanced stage. This results in an enlargement of the LA [45], a decreased atrial contractile function and atrial arrhythmias such as postoperative AF [17,58]. This is not an innocent event [10,17].…”

Section: The Changes At the Atrial And Pulmonary Venous Level Includementioning

confidence: 99%

Heart Failure after Aortic Valve Replacement for Aortic Valve Stenosis: Possible Mechanisms

Mistiaen¹

2014

Int. J. Cardiol. Lipidol. Res.

View full text Add to dashboard Cite

Introduction: Aortic valve stenosis imposes a pressure overload on the left ventricle. Congestive heart failure is one of the complications which can appear, even years after the operation. The main questions are: why do patients still develop heart failure? Which types of congestive heart failure can be expected? Which factors related to it are known? Methods: A literature search was performed with the terms "aortic valve disease/replacement AND heart failure". Some secondary references derived from their reference list were also included. The study design of the selected papers differed considerably. Therefore, the analysis is descriptive and concerns factors which can be related to congestive heart failure. Furthermore, surrogate outcomes are ejection fraction, hypertrophy, long axis ventricular function, torsion, left atrial indices, pressures in the left sided heart and in the pulmonary circulation as well as a number of other echocardiographic parameters. Results: It has become clear that decrease in ejection fraction, which is the most commonly used parameter, occurs late in the course of aortic valve stenosis, when damage to the left ventricle has already been inflicted. Several more sensitive imaging and Doppler parameters can demonstrate these changes earlier in the course of aortic valve stenosis. This damage proves to be irreversible, at least in part. This might explain the appearance of heart failure after aortic valve replacement. Although this type of heart failure is mostly "diastolic" in nature, a continuum with the systolic type probably exists, at least in patients with aortic valve stenosis. Conclusions: Damage to the left ventricle in patients with aortic valve stenosis can go unnoticed if ejection fraction is used as sole determinant of left ventricular function, for the timing of operation. Detection of more subtle changes, even in asymptomatic patients with severe aortic valve stenosis should lead to early replacement. This might result in less postoperative heart failure.

show abstract

“…2,3 The treatment of symptomatic patients with significant AS is well established, whereas the management of asymptomatic patients with severe AS and normal left ventricular ejection fraction (LVEF) is a matter of on-going debate. [4][5][6][7] There are data 4,5 that early aortic valve replacement (AVR) might lead to favourable outcome compared to elective (after symptom onset) surgery. With this respect, there is growing and reasonable interest in adequate risk stratification and identifying the subsets of asymptomatic AS patients who may benefit from early AVR.…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries

Banović

Brković

Nedeljkovic

et al. 2016

Diabetes and Vascular Disease Research

View full text Add to dashboard Cite

Background and aim: Coronary flow reserve is impaired in asymptomatic patients with aortic stenosis and has a prognostic value. We investigated whether the type II diabetes mellitus additionally impairs microvascular circulation assessed by coronary flow reserve in patients with asymptomatic severe aortic stenosis, normal left ventricular ejection fraction and nonobstructed coronary arteries. Methods: A total of 128 patients, mean age of 66.35 ± 10.51 (58.6% males), with severe aortic stenosis and normal left ventricular ejection fraction were enrolled in this study. Patients with diabetes mellitus, those who were treated for diabetes mellitus or had documentation confirming the diagnosis of diabetes mellitus, were considered. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter), standard transthoracic Doppler-echocardiographic study and adenosine stress transthoracic echocardiography for coronary flow reserve measurement. Results: Diabetes mellitus was present in 26 patients (20.31%). There was no significant difference in aortic stenosis severity between diabetic and non-diabetic patients [aortic valve area (0.81 ± 0.18 vs 0.85 ± 0.15 cm 2 ) and V max (4.20 ± 0.57 vs 4.21 ± 0.48 m/s)]. Mean coronary flow reserve in diabetic patients was 1.98 ± 0.48, while mean coronary flow reserve in non-diabetic patients was 2.64 ± 0.54 (p < 0.01). Diabetes mellitus was independent predictor of coronary flow reserve [B = −0.636, 95% confidence interval (−0.916 to −0.368), p < 0.001]. Conclusion: Diabetes mellitus additionally impairs coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.

show abstract

Early valve replacement for aortic stenosis irrespective of symptoms results in better clinical survival: A meta-analysis of the current evidence

Cited by 9 publications

References 30 publications

Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report

Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report

Heart Failure after Aortic Valve Replacement for Aortic Valve Stenosis: Possible Mechanisms

Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries

Contact Info

Product

Resources

About