Treatment strategies for mixed aortic valve disease in nonelderly patients

Stumm, M. von; Petersen, Johannes; Westermann, Dirk; Reichenspurner, Hermann; Girdauskas, Evaldas

doi:10.1080/14779072.2019.1702520

Cited by 3 publications

(4 citation statements)

References 74 publications

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“…The three most common aetiologies of mixed AS/AR are bicuspid aortic valve (BAV), rheumatic heart disease and calcific (degenerative) aortic valve disease 8. The distribution of these aetiologies varies worldwide by age, sex, rheumatic heart disease prevalence and cardiovascular disease risk factors (figure 1).…”

Section: Aetiologiesmentioning

confidence: 99%

“…These patients initially present with isolated AR and develop concurrent AS with age 10 11. BAV can be suspected in patients with mixed AS/AR younger than 55 years of age from high development index countries 8. In contrast, rheumatic heart disease is the most common cause of mixed AS/AR in patients younger than 55 years in low development index countries 8 9.…”

Section: Aetiologiesmentioning

confidence: 99%

“…BAV can be suspected in patients with mixed AS/AR younger than 55 years of age from high development index countries 8. In contrast, rheumatic heart disease is the most common cause of mixed AS/AR in patients younger than 55 years in low development index countries 8 9. Mixed AS/AR is found in 1.7% of patients with rheumatic heart disease in high prevalence regions 12.…”

Section: Aetiologiesmentioning

confidence: 99%

“…For patients less than 55 years of age, surgical AVR is the choice of treatment and 19.4% of patients who undergo surgical AVR have mixed AS/AR 20. There is currently no good surgical valvular substitute among young patients and the benefit seen in TAVI in patients with mixed AS/AR is not seen in surgical AVR as rarely do patients experience immediate perioperative residual AR 8. The Ross procedure, or pulmonary autograft, is the one intervention that could restore lifespan in young patients, but can only be undertaken in those with ideal anatomy and should be used cautiously in those with AR 49.…”

Section: Managementmentioning

confidence: 99%

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Mixed aortic stenosis and regurgitation: a clinical conundrum

Nedadur

Belzile

Farrell

et al. 2022

Heart

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Mixed aortic stenosis (AS) and aortic regurgitation (AR) is the most frequent concomitant valve disease worldwide and represents a heterogeneous population ranging from mild AS with severe AR to mild AR with severe AS. About 6.8% of patients with at least moderate AS will also have moderate or greater AR, and 17.9% of patients with at least moderate AR will suffer from moderate or greater AS. Interest in mixed AS/AR has increased, with studies demonstrating that patients with moderate mixed AS/AR have similar outcomes to those with isolated severe AS. The diagnosis and quantification of mixed AS/AR severity are predominantly echocardiography-based, but the combined lesions lead to significant limitations in the assessment. Aortic valve peak velocity is the best parameter to evaluate the combined haemodynamic impact of both lesions, with a peak velocity greater than 4.0 m/s suggesting severe mixed AS/AR. Moreover, symptoms, increased left ventricular wall thickness and filling pressures, and abnormal left ventricular global longitudinal strain likely identify high-risk patients who may benefit from closer follow-up. Although guidelines recommend interventions based on the predominant lesion, some patients could potentially benefit from earlier intervention. Once a patient is deemed to require intervention, for patients receiving transcatheter valves, the presence of mixed AS/AR could confer benefit to those at high risk of paravalvular leak. Overall, the current approach of managing patients based on the dominant lesion might be too reductionist and a more holistic approach including biomarkers and multimodality imaging cardiac remodelling and inflammation data might be more appropriate.

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Section: Aetiologiesmentioning

confidence: 99%

Section: Aetiologiesmentioning

confidence: 99%

Section: Aetiologiesmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Mixed aortic stenosis and regurgitation: a clinical conundrum

Nedadur

Belzile

Farrell

et al. 2022

Heart

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Focus on a rare clinical entity: unicuspid aortic valve disease

Naito¹,

Sequeira-Gross²,

Petersen³

et al. 2020

Expert Review of Cardiovascular Therapy

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Dual-source CT with metal sphere-tube for preoperative evaluation of patients with aortic valve disease treated by transcatheter aortic valve implantation

Liu

Jiang

et al. 2023

mat express

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To predict the effects of Dual-source CT imaging technology for preoperative patients with transcatheter aortic valve implantation. This is a parallel, randomly allocated to following two groups: patients with the Dual-source CT imaging technology and with conventional imaging technology, and the clinical material from two groups patients with Aortic valve disease are collected, and the images quality between two group are assessed and then complications in one month after surgery are recorded by follow-up. Our outcomes show that patients by the Dual-source CT imaging technology show less complications compared to patients by conventional imaging technology and imaging quality is better than that in conventional imaging group. In addition, image noise, and contrast-to-noise ratio are also examined by Dual-source CT imaging. We can conclude that the Dual-source CT can effectively reduce the complications, and the Dual-source CT can predict effects of preoperative patients with Aortic valve disease and prevent the development of Aortic valve disease (AVD).

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Treatment strategies for mixed aortic valve disease in nonelderly patients

Cited by 3 publications

References 74 publications

Mixed aortic stenosis and regurgitation: a clinical conundrum

Mixed aortic stenosis and regurgitation: a clinical conundrum

Focus on a rare clinical entity: unicuspid aortic valve disease

Dual-source CT with metal sphere-tube for preoperative evaluation of patients with aortic valve disease treated by transcatheter aortic valve implantation

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