The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis

Brown, Morgan L.; Pellikka, Patricia A.; Schaff, Hartzell V.; Scott, Christopher G.; Mullany, Charles J.; Sundt, Thoralf M.; Dearani, Joseph A.; Daly, Richard C.; Orszulak, Thomas A.

doi:10.1016/j.jtcvs.2007.08.058

Cited by 144 publications

(69 citation statements)

References 16 publications

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“…In this study, left ventricle ejection fraction was lower in the refusal group. Worsening patient condition from myocardium overload causes worsening HF and reduces cardiac function 21, 22. Such overload of the myocardium may also lead to a higher risk of falling, decreased mobility, and decreased ability to perform basic activities of daily living, which, in turn, results in increased frailty 23, 24.…”

Section: Discussionmentioning

confidence: 99%

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Shimura

Yamamoto

Kano

et al. 2018

JAHA

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BackgroundAlthough transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR.Methods and ResultsWe used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non‐refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non‐refusal group (P<0.05 for all). Periprocedural complications did not differ between groups, whereas 30‐day and cumulative 1‐year mortality were significantly higher in the refusal group than in the non‐refusal group (7.1% versus 1.3%, P=0.008 and 28.8% versus 10.3%, P=0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52–7.48; P=0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months).ConclusionsRefusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.

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Section: Discussionmentioning

confidence: 99%

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Shimura

Yamamoto

Kano

et al. 2018

JAHA

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“…et l'autolimitation à l'effort font qu'un nombre croissant de patients porteurs d'une SA sévère rapportent peu ou pas de symptômes d'effort. Ces patients sont de faux asymptomatiques et partagent un pronostic défavo-rable en l'absence de traitement curatif [8,9].…”

Section: Introductionunclassified

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Bensahi

Elfhal

Magné

et al. 2015

Annales de Cardiologie et d'Angéiologie

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“…Recent series reported that early surgery, i.e. aortic valve replacement (AVR) in asymptomatic patients and preserved left ventricular (LV) function, was associated with improved clinical outcomes [2,3]. Although AVR is safe and widely performed, the rates of both operative mortality and valve-related complications cannot be overlooked.…”

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confidence: 99%

“…Natural killer (NK) cells principally contribute to innate immunity and adaptive immune responses by killing target cells or by prompting the productions of various cytokines and chemokines [2]. Due to these properties, NK cells play significant roles in the control of microbial infections [3].…”

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confidence: 99%

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

Henri

Magné

Laaraibi

et al. 2014

International Journal of Cardiology

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Aortic stenosis (AS) is the most common valvular heart disease in western countries [1]. Recent series reported that early surgery, i.e. aortic valve replacement (AVR) in asymptomatic patients and preserved left ventricular (LV) function, was associated with improved clinical outcomes [2,3]. Although AVR is safe and widely performed, the rates of both operative mortality and valve-related complications cannot be overlooked. The risk-benefit ratio of early strategy should be carefully evaluated and the decision-making could be refined by quantitative and reliable parameters. In this regard, the recently updated ESC guidelines suggest the usefulness of B-type natriuretic peptide (BNP) level measurement [4]. The aim of this study was to identify resting and exercise echocardiographic determinants of BNP level in asymptomatic patients with AS and preserved LV function.We prospectively included 61 asymptomatic patients with at least moderate AS (aortic valve area b1.5 cm 2 ) and preserved LV ejection fraction (N50%) that were referred to our Heart Valve Clinic to perform resting and exercise Doppler echocardiography with concomitant BNP level measurement. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee and all patients gave written informed consent.Patients were divided into 2 groups according to BNP level median (66 pg/mL). All patients presented at least a moderate AS (1.0 ± 0.3 cm 2 ; range: 0.4-1.5 cm 2 ) and preserved LV ejection fraction (69 ± 7%; range: 55-81%). Mean age of the population was 70 ± 13 (range: 31-87) years old and a significant correlation between age and BNP levels was found (r = 0.40; p = 0.001). The distribution of BNP levels was 104 ± 142 pg/mL; median: 66; range: 5-700 pg/mL. Patients in the high BNP level group were significantly older (p b 0.001), more often in atrial fibrillation (p b 0.001) or with hypertension (p = 0.048). There were no other significant differences regarding clinical characteristics. Patients in the high BNP level group had significant higher indexed left atrial area (p = 0.017) and E/e′ ratio (p = 0.001). There was no significant difference in AS severity and LV mass, volumes and function between groups (Table 1). Significant correlations were found between BNP levels and indexed left atrial area (r = 0.346; p = 0.008), E/A ratio (r = 0.344; p = 0.009) and E/e′ ratio (r = 0.584; p b 0.001, Fig. 1b). After adjustment for age, indexed aortic valve area, LV global longitudinal strain and left atrial area, multivariable analysis identified E/e′ (β = 18.2 ± 2.9; p b 0.001) and LV end-diastolic volume (β = −2.1 ± 0.7; p = 0.006) as independent resting predictors of BNP level.Patients in the high BNP level group had significant higher exercise E/e′ ratio (p = 0.018) and lower LV global longitudinal strain (p = 0.020). There was no difference in AS severity, LV stroke volume and ejection fraction between groups (Table 1). Significant correlations were fou...

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The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis

Cited by 144 publications

References 16 publications

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Sténose aortique sévère asymptomatique à fraction d’éjection ventriculaire gauche préservée. Évaluation à l’effort : quels résultats et quelles décisions ?

Brain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants

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