scholarly journals Progression of Aortic Stenosis in Patients with Bicuspid Aortic Valve

2021 ◽  
Author(s):  
Michael Shang ◽  
Arianna Kahler-Quesada ◽  
Makoto Mori ◽  
Sameh Yousef ◽  
Arnar Geirsson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Rapid Progression ◽  
Progression Rate

Background: Bicuspid aortic valve is the most common congenital heart defect and predisposes patients to developing aortic stenosis more frequently and at a younger age than the general population. However, the influence of bicuspid aortic valve on the rate of progression of aortic stenosis remains unclear. Methods: In 236 patients (177 tricuspid aortic valve, 59 bicuspid aortic valve) matched by initial severity of mild or moderate aortic stenosis, we retrospectively analyzed baseline echocardiogram at diagnosis with latest available follow-up echocardiogram. Baseline comorbidities, annualized progression rate of hemodynamic parameters, and hazard of aortic valve replacement were compared between valve phenotypes. Results: Median echocardiographic follow-up was 2.6 (IQR 1.6-4.2) years. Patients with tricuspid aortic stenosis were significantly older with more frequent comorbid hypertension and congestive heart failure. Median annualized progression rate of mean gradient was 2.3 (IQR 0.6-5.0) mmHg/year vs. 1.5 (IQR 0.5-4.1) mmHg/year (p=0.5), and that of peak velocity was 0.14 (IQR 0-0.31) m/s/year vs. 0.10 (IQR 0.04-0.26) m/s/year (p=0.7) for tricuspid vs. bicuspid aortic valve, respectively. On multivariate analyses, bicuspid aortic valve was not significantly associated with more rapid progression of aortic stenosis. In a stepwise Cox proportional hazards model adjusted for baseline mean gradient, bicuspid aortic valve was associated with increased hazard of aortic valve replacement (HR: 1.7, 95% CI [1.0, 3.0], p=0.049). Conclusion: Bicuspid aortic valve may not significantly predispose patients to more rapid progression of mild or moderate aortic stenosis. Guidelines for echocardiographic surveillance of aortic stenosis need not be influenced by valve phenotype.

scholarly journals Ten-year follow-up of unreplaced Valsalva sinuses after aortic valve replacement in bicuspid aortic valve disease

2019 ◽  
Vol 112 (5) ◽  
pp. 305-313 ◽  
Author(s):  
Ramzi Abi Akar ◽  
Noémie Tence ◽  
Jérome Jouan ◽  
Wassim Borik ◽  
Philippe Menasché ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Valve Disease

scholarly journals Severe aortic stenosis in octogenarian: is surgical aortic valve replacement a good option?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
R Menezes Fernandes ◽  
HA Costa ◽  
JS Bispo ◽  
TF Mota ◽  
D Bento ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Older Patients ◽  
Independent Predictor ◽  
Advanced Age ◽  
Surgical Aortic Valve Replacement ◽  
Predictors Of Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, reaching 8,1% in 85 years-old patients. Symptomatic severe AS entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk. Purpose To determine the prognostic impact of advanced age in patients with severe AS referred to surgical valve replacement. Methods We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe AS, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: <80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p = 0,05. Results A total of 222 patients were included, with a 64,4% male predominance and a median age of 75 years old. 27,5% had concomitant surgical coronary artery disease and 87,4% waited in an out-patient setting. Median delay until surgery was 87 days and median follow-up after surgical referral was 517 days. 59 patients (26,8%) had ≥ 80 years old. Male gender (69,6% vs 50,8%; p = 0,01), smoking habits (14,3% vs 1,7%; p = 0,024), higher glomerular filtration rate (75,5 vs 63,2 ml/min; p = 0,001) and lower Euroscore II values (2,89% vs 4,64%; p = 0,003) were more common in younger patients. Global mortality rate (27,1% vs 15,5%; p = 0,05) and the composite of mortality or re-hospitalization (52,5% vs 36,6%; p = 0,034) were more frequent in older patients. Despite re-hospitalizations were also more common (37,3% vs 29,2%), they did not reach statistical significance (p = 0,252). After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p = 0,007; p = 0,006) and pulmonary hypertension (p = 0,004; p = 0,002) were both independent predictors of mortality and the composite of mortality or re-hospitalization. Conclusion Older patients with AS have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform aortic valve replacement should be discussed in the Heart Team, considering patient’s comorbidities and performing a comprehensive geriatric evaluation, not just focusing on age itself.

Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis

2021 ◽  
Author(s):  
Victoria Vilalta ◽  
Alberto Alperi ◽  
Germán Cediel ◽  
Siamak Mohammadi ◽  
Eduard Fernández-Nofrerias ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Hazard Ratio ◽  
Low Risk ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Baseline Characteristics

Background: Sutureless-surgical aortic valve replacement (SU-SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU-SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis. Methods: A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected. Results: Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%–2.5%) in both SU-SAVR and TAVR groups ( P =0.85). There were no statistically significant differences regarding in-hospital mortality (SU-SAVR: 4.1%, TAVR: 1.8%, P =0.199) and stroke (SU-SAVR: 2.3%, TAVR: 2.9%, P =0.736), but SU-SAVR recipients exhibited higher rates of bleeding and new-onset atrial fibrillation, higher residual transvalvular gradients ( P <0.001), and a lower rate of pacemaker implantation ( P =0.011). After a median follow-up of 2 (1–3) years, there were no differences between groups in all-cause mortality (hazard ratio, 0.97 [95% CI, 0.52–1.82], P =0.936) and stroke (hazard ratio, 0.83 [95% CI, 0.32–2.15], P =0.708), but SU-SAVR was associated with a higher risk of heart failure hospitalization (hazard ratio, 5.38 [95% CI, 1.88–15.38], P =0.002). Conclusions: In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients.

Abstract 18719: Relationship Between Proximal Aorta Morphology and Progression Rate of Aortic Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Romain Capoulade ◽  
Philipp Bartko ◽  
Jonathan G Teoh ◽  
Elisa Teo ◽  
Yong H Park ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Morphological Changes ◽  
Progression Rate ◽  
Normal Range ◽  
Sinotubular Junction ◽  
Arterial Hemodynamics ◽  
Different Levels

Background: Morphological changes of the proximal aorta, such as effacement of the sinotubular junction (STJ), may result in increased mechanical stress on the aortic valve leaflets and contribute to calcification and progression of aortic stenosis (AS). The aim of this study was to examine the association between abnormal morphology of proximal aorta and AS progression rate. Methods: Between 2010 and 2012, 426 patients with mild to moderate AS (peak aortic jet velocity >2.5 and <4 m/s) and LVEF≥50% with at least two years of follow up were included in this study. Aortic dimensions were measured at 3 different levels: sinus of Valsalva (SVal), STJ and ascending aorta (Aa). The ratios of SVal by STJ (SVal/STJ) and Aa by STJ (Aa/STJ) were used to determine degree of aortic deformity with smaller ratios consistent with greater perturbation of normal geometry. SVal/STJ<1.13 and Aa/STJ<1.09 were defined as significant low ratios per normal range reported in Guidelines. AS progression rate was assessed by annualized increase in mean gradient (MG; follow-up time = 3.2±0.8 yrs). Results: Mean age was 71±13 yrs and 64% were male. 16% had bicuspid aortic valve and MG was 21±8 mmHg. SVal, STJ and Aa dimensions were respectively 33±4 mm, 27±4 mm and 36±5 mm. Mean SVal/STJ ratio was 1.21±0.15 and Aa/STJ ratio was 1.29±0.19. Patients with significant low ratios had faster AS progression (p≤0.05; figure). After adjustment for age, gender, hypertension, diabetes, renal disease, bicuspid aortic valve, baseline MG, LVEF, aortic regurgitation and indexed STJ, SVal/STJ (p=0.025) or Aa/STJ (p=0.027) were independently associated with faster AS progression. Conclusion: Abnormal aortic root geometry such as effacement of the sinotubular junction is a strong and independent predictor of faster AS progression, regardless of arterial hemodynamics, aortic valve phenotype and baseline AS severity. This finding suggests an interrelation between proximal aorta morphology and stenosis progression.

P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
F Carrasco-Chinchilla ◽  
A J Dominguez-Franco ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Abstract Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis. Methods From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old Results The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months. Conclusions TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.

scholarly journals Bicuspid aortic valve with severe aortic stenosis: a case report

2016 ◽  
Vol 44 (2) ◽  
pp. 105-108
Author(s):  
Redoy Ranjan ◽  
Md Mushfiqur Rahman ◽  
Omar Sadeque Khan ◽  
Md Aftabuddin ◽  
Asit Baran Adhikary
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Color Doppler ◽  
Flow Through ◽  
High Record

A bicuspid aortic valve (BAV) can be a serious disorder of heart valve in which the valve only has two leaflets or flaps that control blood flow through the heart. Between one and two percent of all people have this defect and it affects more men than women. This report presents a case of severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with hypertension. A 37 years old male presented with high record of blood pressure and occasional shortness of breath on exertion. Echocardiography (Color Doppler) revealed severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with moderately severe concentric LV wall hypertrophy. Surgical treatment (aortic valve replacement) was scheduled based on echocardiography findings. On surgical resection a well defined bicuspid aortic valve was found with calcification and friable valve leaflet. Histopathology of valve tissue shows large areas of calcification. Patient was discharged from hospital on 7th POD with an advice to attend cardiac surgery OPD after 1 month. Aortic valve replacement must be considered in this type of lesion.Bangladesh Med J. 2015 May; 44 (2): 105-108

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