Bicuspid aortic valve and diseases of the aorta
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček in Congenital Heart Disease in Adults, 2008
Aortic valve replacement is carried out using a mechanical prosthesis, a biological valve (xenograft), a human valve (allograft), or Ross procedure (pulmonary autograft). In some cases, aortic valvuloplasty retaining the patient’s own valve is possible. Aortic root dilatation requires root reconstruction, or aortic root and valve replacement by a homo-graft (allograft), or a composite graft with mechanical prosthesis (Bentall’s procedure), or a valve-sparing operation (root remodeling technique or reimplantation of the own aortic valve into the prosthesis).
Valve disease
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
Aortic valvuloplasty for aortic stenosis is a percutaneous procedure that is used only occasionally to widen (or crack open) a calcified and severely narrowed aortic valve. It is only occasionally used for elderly patients with severe aortic stenosis who, because of coexisting conditions, are considered too high risk for aortic valve replacement. The procedure has a high mortality rate and a high risk of cerebral emboli, and restenosis within one year. Complications occur in at least 10% of patients.
Sex differences in aortic stenosis: from pathophysiology to treatment
Published in Expert Review of Cardiovascular Therapy, 2020
Sahrai Saeed, Marc R Dweck, John Chambers
The prognosis is good when the patient is asymptomatic. However, as soon as symptoms develop, there is a sharp increase in the risk of sudden death both in men and women if left untreated [80–83]. No medical treatment has so far been shown to reduce the rate of progression of aortic valve calcification or the risk of clinical events. Specifically, three major randomized clinical trials (the Scottish Aortic Stenosis and Lipid-Lowering Trial [SALTIRE], the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS], and the AS Progression Observation: Measuring Effects of Rosuvastatin [ASTRONOMER]) studies have failed to show any benefit from lipid-lowering therapy on AS progression rate or outcome [84–86]. Hence, surgical AVR or TAVI are the only treatment options. Balloon aortic valvuloplasty may be considered as a palliative treatment option or bridge to AVR or TAVI in patients with severe AS. In a study by Daniec et al. no differences was found in the indications or long-term outcome after balloon aortic valvuloplasty in men and women with AS, although there were some sex differences in baseline characteristics and vascular complications [87].
Beyond the Valve and into the Muscle: A Review of Coexisting Aortic Stenosis and Transthyretin Cardiac Amyloidosis
Published in Structural Heart, 2019
Hannah Rosenblum, David L. Narotsky, Nadira Hamid, Rebecca T. Hahn, Susheel Kodali, Tamim Nazif, Omar K. Khalique, Sabahat Bokhari, Mathew S. Maurer, Adam Castaño
Long-term mortality data for patients with ATTR-CA and severe AS undergoing aortic valve replacement are lacking, but these data would have an important clinical impact. There remains equipoise even with the few available studies on the impact of concurrent ATTR-CA among patients with severe AS undergoing aortic valve replacement. Short-term follow-up from two of the aforementioned studies suggests decreased survival in severe AS patients with ATTR-CA undergoing aortic valve replacement compared with patients without ATTR-CA (Table 1).12,21 Additionally, a study of 171 consecutive patients with ATTR-CA, both with (N = 27) and without AS (N = 144), found a similar mortality at 2 years, even in 11 of the 27 patients with ATTR-CA who underwent surgical AVR.23 The authors proposed that the mortality in patients with both diseases may be driven by ATTR-CA, as opposed to the severe AS, and therefore mortality was not mitigated by aortic valve replacement. A single center experience of five patients, who were referred for aortic valve surgery and found to have ATTR-CA, ultimately underwent balloon aortic valvuloplasty as a bridge to further evaluation before pursuing more invasive procedures.24 These patient outcomes have not been reported, but emphasize the need for future studies to understand the trajectory of patients with concurrent disease states and to determine appropriate management strategies.
Long-term patency of rescue stenting of an anomalous left circumflex coronary artery after transcatheter aortic valve replacement
Published in Baylor University Medical Center Proceedings, 2023
Corry B. Sanford, Jonathan P. Urbanczyk, Timothy A. Mixon
Various outcomes have occurred during TAVR with an anomalous LCX, ranging from nonocclusion to acute occlusion requiring bailout stenting.2,3 In one case report, pre-TAVR balloon aortic valvuloplasty was performed to assess for potential occlusion. Compromise was noted and the patient’s management was altered to a surgical approach.4 Although rare, acute coronary obstruction after TAVR (0.7% of all cases) can be fatal.5 A systematic review described 24 patients with acute coronary artery obstruction after TAVR. Intervention was performed in all but one and was successful in all but two, leading to a mortality rate of 8.3%.6 Acute obstruction typically occurs in the procedure lab but may rarely occur hours or days later. Delayed coronary artery obstruction after TAVR has been described in 0.224% of patients and leads to an in-hospital death rate of 50%.7 The incidence of coronary artery occlusion during TAVR may be decreased with careful preprocedural anatomic evaluation. In a patient like ours with an 80% proximal anomalous LCX lesion, it is imperative to prepare for complications; in this case, such preparation led to a successful procedure. It is unknown whether pre-TAVR stenting would be sufficiently safe and effective, or if the type of valvular prosthesis chosen might mitigate the risk.
Related Knowledge Centers
- Aortic Stenosis
- Aortic Valve
- Aortic Valve Replacement
- Balloon Catheter
- Cardiogenic Shock
- Congenital Heart Defect
- Palliative Care
- Pulmonary Edema
- Percutaneous Aortic Valve Replacement
- Hypoplastic Left Heart Syndrome