Timing of surgery for asymptomatic patients with severe aortic valve stenosis: An updated systematic review and meta-analysis

Wei, Changmin; Li, Zhen; Xu, Congjian; Yin, Tongming; Zhao, Chen

doi:10.1016/j.hjc.2021.01.005

Cited by 6 publications

(2 citation statements)

References 35 publications

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“…However, these studies demonstrated clear benefits of earlier surgical intervention for asymptomatic severe AS compared to conservative treatment. Meta-analyses have also confirmed that earlier intervention reduces cardiovascular mortality and all-cause mortality compared to a watchful waiting strategy [ 14 , 15 ]. Prolonged pressure overload in severe AS leads to structural and functional changes in the LV, which may have unfavorable clinical consequences, such as the development of heart failure with a preserved LV ejection fraction [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

et al. 2023

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Aim of the study: The aim of this study was to perform a comparative analysis of severity of discordant aortic stenosis (AS) assessment using multiposition scanning and the standard apical window. Materials and Methods: All patients (n = 104) underwent preoperative transthoracic echocardiography (TTE) and were ranked according to the degree of AS severity. The reproducibility feasibility of the right parasternal window (RPW) was 75.0% (n = 78). The mean age of the patients was 64 years, and 40 (51.3%) were female. In 25 cases, low gradients were identified from the apical window not corresponding to the visual structural changes in the aortic valve, or disagreement between the velocity and calculated parameters was detected. Patients were divided into two groups: concordant AS (n = 56; 71.8%) and discordant AS (n = 22; 28.2%). Three individuals were excluded from the discordant AS group due to the presence of moderate stenosis. Results: Based on the comparative analysis of transvalvular flow velocities obtained from multiposition scanning, the concordance group showed agreement between the velocity and calculated parameters. We observed an increase in the mean transvalvular pressure gradient (ΔPmean) and peak aortic jet velocity (Vmax), ΔPmean in 95.5% of patients, velocity time integral of transvalvular flow (VTI AV) in 90.9% of patients, and a decrease in aortic valve area (AVA) and indexed AVA in 90.9% of patients after applying RPW in all patients with discordant AS. The use of RPW allowed the reclassification of AS severity from discordant to concordant high-gradient AS in 88% of low-gradient AS cases. Conclusion: Underestimation of flow velocity and overestimation of AVA using the apical window may lead to misclassification of AS. The use of RPW helps to match the degree of AS severity with the velocity characteristics and reduce the number of low-gradient AS cases.

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Section: Discussionmentioning

confidence: 99%

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

et al. 2023

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“…Pacientes com EA de alto gradiente, avaliados pela ecocardiografia com um gradiente médio maior que 40 mmHg, área da válvula menor que 1 cm 2 e velocidade máxima maior que 4 m/s devem ser considerados com EA grave, independente dos outros parâmetros (BERGLUND, 2018;WEI et al, 2021;HAMADA;ABDELGHANI;SARDAR, 2022).…”

Section: Diagnósticounclassified

Estenose aórtica grave assintomática: atuais perspectivas terapêuticas

Vargas¹,

Piumbini²,

Moreira³

et al. 2023

Braz. J. Hea. Rev.

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A estenose aórtica (EA) é uma valvulopatia comum na prática clínica e a substituição cirúrgica da válvula é indicada para os casos graves sintomáticos. Entretanto, para os casos assintomáticos o tratamento permanece controverso. Estudos indicam que grande parte desses pacientes apresentarão sintomas nos próximos anos, necessitando de cirurgia, e que, nesse período, o risco de danos cardíacos irreversíveis aumentam. Por outro lado, a intervenção precoce também oferece riscos. A avaliação inicial da EA grave assintomática consiste em diversas modalidades de exames e a ecocardiografia é utilizada para a avaliação da etiologia, gravidade e progressão da doença. É considerado como EA grave pacientes que apresentarem gradiente médio maior que 40 mmHg, área da válvula menor que 1 cm2 e velocidade máxima maior que 4 m/s na ecocardiografia. Entretanto, outros exames também podem ser úteis, como teste de esforço, ressonância magnética, eletrocardiograma, hemograma, eletrólitos séricos e biomarcadores cardíacos. Normalmente, a cirurgia para a EA grave assintomática é indicada quando a fração de ejeção ventricular esquerda for menor ou igual a 50%, quando houver baixo risco cirúrgico e quando o teste de esforço for anormal. Em contrapartida, a cirurgia é contraindicada quando esta é improvável de melhorar a qualidade de vida e em pacientes que possuem comorbidades graves. Quanto à técnica, há a substituição cirúrgica da válvula aórtica e a substituição transcateter da válvula aórtica, uma alternativa menos invasiva. Embora a decisão entre espera vigilante ou cirurgia precoce para os pacientes com EA assintomática grave ainda não seja bem estabelecida, a chave para o gerenciamento consiste em uma abordagem multidisciplinar e na preferência do paciente.

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Management of severe aortic stenosis in asymptomatic patients in the new AVATAR

Narayan

2022

Indian J Thorac Cardiovasc Surg

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Timing of surgery for asymptomatic patients with severe aortic valve stenosis: An updated systematic review and meta-analysis

Cited by 6 publications

References 35 publications

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

Estenose aórtica grave assintomática: atuais perspectivas terapêuticas

Management of severe aortic stenosis in asymptomatic patients in the new AVATAR

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