Timing of surgery in aortic stenosis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Aortic valve stenosis (AVS) usually results from three distinct processes (degenerativecalcific, rheumatic, and congenital), with a final common pathway of significant aortic outflow tract obstruction. The stenotic lesion tends to progress slowly, but once symptoms develop clinical deterioration can ensue rapidly. Chest pain, dyspnea, and syncope are the most common symptoms of significant AVS. Detection of symptoms, subtle or obvious, is critical to the management of AVS because their presence portends a worse overall prognosis and is an indication for intervention. There are several special clinical scenarios that require added consideration, including individuals with concomitant coronary artery disease, the presence of a relatively small transvalvular pressure gradient in the setting of low cardiac output (so-called low-gradient AVS), and elderly with severe AVS. Surgical aortic valve replacement (AVR) is the mainstay treatment for relief of obstruction in patients with symptomatic AVS. Percutaneous balloon valvuloplasty is reserved for the small minority of patients who are not surgical candidates and is associated with a high restenosis rate. Percutaneous AVR is a new technology that is being tested in a few select centers on patients who are not operative candidates.
- Stewart BF, Siscovick D, Lind BK, et al.: Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997, 29:630–634. CrossRef
- Gorlin R, Gorlin SG: Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J 1951, 41:1–29. CrossRef
- Ross J Jr, Braunwald E: Aortic stenosis. Circulation 1968, 38:61–67.
- Vincentelli A, Susen S, Le Tourneau T, et al.: Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med 2003, 349:343–349. CrossRef
- Freeman RV, Otto CM: Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation 2005, 111:3316–3326. CrossRef
- Pohle K, Maffert R, Ropers D, et al.: Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors. Circulation 2001, 104:1927–1932.
- Rosenhek R, Rader F, Loho N, et al.: Statins but not angiotensin-converting enzyme inhibitors delay progression of aortic stenosis. Circulation 2004, 110:1291–1295. CrossRef
- Cowell SJ, Newby DE, Prescott RJ, et al.: A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med 2005, 352:2389–2397. In a prospective trial of 155 patients, intensive lipid-lowering therapy (atorvastatin 80 mg every day) did not reduce the progression of AVS (as measured by velocity across the aortic valve) or valvular calcification, but there was a trend toward decreased need for AVR. CrossRef
- Khot UN, Novaro GM, Popovic ZB, et al.: Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis. N Engl J Med 2003, 348:1756–1763. CrossRef
- Lieberman EB, Bashore TM, Hermiller JB, et al.: Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol 1995, 26:1522–1528. CrossRef
- Otto CM, Mickel MC, Kennedy JW, et al.: Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation 1994, 89:642–650.
- Otto CM, Burwash IG, Legget ME, et al.: Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997, 95:2262–2270.
- Schwarz F, Baumann P, Manthey J, et al.: The effect of aortic valve replacement on survival. Circulation 1982, 66:1105–1110.
- Connolly HM, Oh JK, Orszulak TA, et al.: Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 1997, 95:2395–2400.
- Lange RA, Hillis LD: Dobutamine stress echocardiography in patients with low-gradient aortic stenosis. Circulation 2006, 113:1718–1720. CrossRef
- Quere JP, Monin JL, Levy F, et al.: Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis. Circulation 2006, 113:1738–1744. CrossRef
- Bonow RO, Carabello B, Chatterjee K, et al.: ACC/AHA 2006 Guidelines for the Management of Patients with Valvular Heart Disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of patients with Valvular Heart Disease). J Am Coll Cardiol 2006, 48:e1–e148. Accessible online at http:// www.americanheart.org/presenter.jhtml?identifier= 3040213. This recent update of the American College of Cardiology/American Heart Association guidelines presents an excellent summary of data relevant to the management of patients with AVS.
- Asimakopoulos G, Edwards MB, Taylor KM: Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK Heart Valve Registry. Circulation 1997, 96:3403–3408.
- Timing of surgery in aortic stenosis
Current Treatment Options in Cardiovascular Medicine
Volume 8, Issue 6 , pp 421-427
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links