BACKGROUND: Intervention is advised in selected asymptomatic patients with aortic valve disease. However, little is known regarding their actual management. METHODS: The Euro Heart Survey was designed to evaluate practices. Severe isolated aortic stenosis (AS) was defined by a valve area < or = 0.6 cm2/m2 body surface area or mean gradient > or = 50 mm Hg. Severe aortic regurgitation (AR) was defined by a grade > or = 3/4. Patients were classified as asymptomatic when they were in New York Heart Association class I and were without angina. Decision to operate was analyzed by comparing patient characteristics with the American College of Cardiology/American Heart Association recommendations. RESULTS: Of the 5001 patients, 136 had severe, isolated, and asymptomatic aortic valve disease (84 with AS and 52 with AR). Stress testing was performed in only 6 patients (4%). A decision to operate was taken in 45 patients (54%) with AS and 21 (40%) with AR. Indications for surgery were in accordance with the American College of Cardiology/American Heart Association guidelines in 57 patients (68%) with AS and in 41 (83%) with AR. However, the decision to operate was frequently based on class IIb recommendations in patients with AS. Intervention was "overused" in 18 patients with AS (21%) and in 5 (9%) with AR. Intervention was "underused" in 9 patients (11%) with AS and in 4 (8%) with AR. CONCLUSIONS: In asymptomatic patients with severe aortic valve disease, a decision to operate is frequently taken; and it is most often in agreement with guidelines, although often based on low-level recommendations.
BACKGROUND: Intervention is advised in selected asymptomatic patients with aortic valve disease. However, little is known regarding their actual management. METHODS: The Euro Heart Survey was designed to evaluate practices. Severe isolated aortic stenosis (AS) was defined by a valve area < or = 0.6 cm2/m2 body surface area or mean gradient > or = 50 mm Hg. Severe aortic regurgitation (AR) was defined by a grade > or = 3/4. Patients were classified as asymptomatic when they were in New York Heart Association class I and were without angina. Decision to operate was analyzed by comparing patient characteristics with the American College of Cardiology/American Heart Association recommendations. RESULTS: Of the 5001 patients, 136 had severe, isolated, and asymptomatic aortic valve disease (84 with AS and 52 with AR). Stress testing was performed in only 6 patients (4%). A decision to operate was taken in 45 patients (54%) with AS and 21 (40%) with AR. Indications for surgery were in accordance with the American College of Cardiology/American Heart Association guidelines in 57 patients (68%) with AS and in 41 (83%) with AR. However, the decision to operate was frequently based on class IIb recommendations in patients with AS. Intervention was "overused" in 18 patients with AS (21%) and in 5 (9%) with AR. Intervention was "underused" in 9 patients (11%) with AS and in 4 (8%) with AR. CONCLUSIONS: In asymptomatic patients with severe aortic valve disease, a decision to operate is frequently taken; and it is most often in agreement with guidelines, although often based on low-level recommendations.
Authors: Martin Thoenes; Peter Bramlage; Pepe Zamorano; David Messika-Zeitoun; Daniel Wendt; Markus Kasel; Jana Kurucova; Richard P Steeds Journal: J Thorac Dis Date: 2018-09 Impact factor: 2.895
Authors: Norbert Frey; Richard P Steeds; Antonio Serra; Eberhard Schulz; Stephan Baldus; Matthias Lutz; Christiane Pohlmann; Jana Kurucova; Peter Bramlage; David Messika-Zeitoun Journal: BMC Cardiovasc Disord Date: 2017-01-05 Impact factor: 2.298
Authors: Tanja K Rudolph; David Messika-Zeitoun; Norbert Frey; Matthias Lutz; Laura Krapf; Stephanie Passefort; John Fryearson; Helen Simpson; Kai Mortensen; Sebastian Rehse; Andreas Tiroke; Fotini Dodos; Florian Mies; Christiane Pohlmann; Jana Kurucova; Martin Thoenes; Peter Bramlage; Richard Paul Steeds Journal: Open Heart Date: 2019-07-21
Authors: Richard P Steeds; Matthias Lutz; Jeetendra Thambyrajah; Antonio Serra; Eberhard Schulz; Jiri Maly; Marco Aiello; Tanja K Rudolph; Guy Lloyd; Alessandro Santo Bortone; Karl Eugen Hauptmann; Alberto Clerici; Georg Delle-Karth; Johannes Rieber; Ciro Indolfi; Massimo Mancone; Loic Belle; Alexander Lauten; Martin Arnold; Berto J Bouma; Cornelia Deutsch; Jana Kurucova; Martin Thoenes; Peter Bramlage; Norbert Frey; David Messika-Zeitoun Journal: J Am Heart Assoc Date: 2019-09-24 Impact factor: 5.501