Andrés M Pineda1, Todd L Kiefer2. 1. Division of Cardiology - ACC Building 5th floor, University of Florida College of Medicine - Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA. Andres.PinedaMaldonado@jax.ufl.edu. 2. Division of Cardiology, Duke University Hospital, Durham, NC, USA.
Abstract
PURPOSE OF REVIEW: The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients. RECENT FINDINGS: Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients. Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.
PURPOSE OF REVIEW: The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients. RECENT FINDINGS: Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients. Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.
Entities:
Keywords:
Aortic valve; Aortic valve replacement; Asymptomatic; Severe aortic stenosis
Authors: Patricia A Pellikka; Maurice E Sarano; Rick A Nishimura; Joseph F Malouf; Kent R Bailey; Christopher G Scott; Marion E Barnes; A Jamil Tajik Journal: Circulation Date: 2005-06-13 Impact factor: 29.690
Authors: Marie-Annick Clavel; Philippe Pibarot; David Messika-Zeitoun; Romain Capoulade; Joseph Malouf; Shivani Aggarval; Phillip A Araoz; Hector I Michelena; Caroline Cueff; Eric Larose; Jordan D Miller; Alec Vahanian; Maurice Enriquez-Sarano Journal: J Am Coll Cardiol Date: 2014-09-23 Impact factor: 24.094
Authors: Gudrun M Feuchtner; Silvana Müller; Wilhelm Grander; Hannes F Alber; Thomas Bartel; Guy J Friedrich; Markus Reinthaler; Otmar Pachinger; Dieter zur Nedden; Wolfgang Dichtl Journal: J Heart Valve Dis Date: 2006-07
Authors: O Lund; T T Nielsen; K Emmertsen; C Flø; B Rasmussen; F T Jensen; H K Pilegaard; L H Kristensen; O K Hansen Journal: Thorac Cardiovasc Surg Date: 1996-12 Impact factor: 1.827
Authors: Philippe Généreux; Gregg W Stone; Patrick T O'Gara; Guillaume Marquis-Gravel; Björn Redfors; Gennaro Giustino; Philippe Pibarot; Jeroen J Bax; Robert O Bonow; Martin B Leon Journal: J Am Coll Cardiol Date: 2016-04-02 Impact factor: 24.094