Aortic Valve/surgery; Aortic Valve Stenosis/diagnosis/surgery; Echocardiography; Heart Valve Prosthesis; Humans; Severity of Illness Index
Abstract :
[en] Surgical aortic valve replacement is the sole validated treatment of aortic stenosis. The indications for surgery rely on risk/benefit ratio and on the official recommendations. A symptomatic patient with severe aortic stenosis should be submitted to surgery. The indication of valve replacement is more difficult in asymptomatic patients. The decision should integrate a combination of an exercise test and prognostic parameters associated with poor outcome. Most of them are obtained by Doppler echocardiography. Patients presenting with severe aortic stenosis and low transvalvular gradient constitute a subgroup of patients who require appropriate echocardiographic assessment to determine the potential benefit and risk of surgery. Transluminal aortic valve implantation is a new modality for patients at high surgical risk.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Pirlet, C.
Magne, Julien ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Pierard, Luc ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
**Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro heart survey on valvular heart disease. Eur Heart J 2003;24:1231-43. (Pubitemid 36834640)
Soler-Soler J, Galve E. Worldwide perspective of valve disease. Heart 2000;83:721-5. (Pubitemid 30345988)
Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular health study. J Am Coll Cardiol 1997;29:630-4. (Pubitemid 27116107)
*Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the 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): Endorsed by the Society of cardiovascular anesthesiologists, Society for cardiovascular angiography and interventions, and Society of thoracic surgeons. Circulation 2008;118:e523-e661.
**Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The task force on the management of valvular heart disease of the European society of cardiology. Eur Heart J 2007;28:230-68. (Pubitemid 46276943)
*Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr 2009;10:1-25.
Schwarz F, Baumann P, Manthey J, et al. The effect of aortic valve replacement on survival. Circulation 1982;66:1105-10. (Pubitemid 12036848)
Lund O, Kristensen LH, Baandrup U, et al. Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis. Eur Heart J 1998;19:1099-108. (Pubitemid 28321391)
Amato MC, Moffa PJ, Werner KE, et al. Treatment decision in asymptomatic aortic valve stenosis: Role of exercise testing. Heart 2001;86:381-6. (Pubitemid 32889370)
*Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation 2005;111:3290-5. (Pubitemid 40875002)
*Lancellotti P, Donal E, Magne J, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis: The importance of the valvular, arterial and ventricular interplay. Heart 2010;96:1364-71.
Lancellotti P, Moonen M, Magne J, et al. Prognostic effect of long-axis left ventricular dysfunction and Btype natriuretic peptide levels in asymptomatic aortic stenosis. Am J Cardiol 2010;105:383-8.
Bergler-Klein J, Klaar U, Heger M, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation 2004;109:2302-8. (Pubitemid 38678520)
*Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262-70. (Pubitemid 27191003)
Kang DH, Park SJ, Rim JH, et al. Early surgery versus conventional treatment in asymptomatic very severe aortic stenosis. Circulation 2010;121:1502-9.
*Rosenhek R, Zilberszac R, Schemper M, et al. Natural history of very severe aortic stenosis. Circulation 2010;121:151-6.
Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000;343:611-7. (Pubitemid 30659472)
*Monin JL, Lancellotti P, Monchi M, et al. Risk score for predicting outcome in patients with asymptomatic aortic stenosis. Circulation 2009;120:69-75.
Briand M, Dumesnil JG, Kadem L, et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: Implications for diagnosis and treatment. J Am Coll Cardiol 2005;46:291-8. (Pubitemid 40966858)
*Hachicha Z, Dumesnil JG, Pibarot P. Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis. J Am Coll Cardiol 2009;54:1003-11.
**Lancellotti P, Lebois F, Simon M, et al. Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis. Circulation 2005;112:I377-82. (Pubitemid 41266702)
**Das P, Rimington H, Chambers J. Exercise testing to stratify risk in aortic stenosis. Eur Heart J 2005;26:1309-13. (Pubitemid 41435462)
Rafique AM, Biner S, Ray I, et al. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol 2009;104:972-7.
Marechaux S, Hachicha Z, Bellouin A, et al. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis. Eur Heart J 2010;31:1390-7.
Nishimura RA, Grantham JA, Connolly HM, et al. Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: The clinical utility of the dobutamine challenge in the catheterization laboratory. Circulation 2002;106:809-13.
Blais C, Burwash IG, Mundigler G, et al. Projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis: The multicenter TOPAS (Truly or pseudo-severe aortic stenosis) study. Circulation 2006;113:711-21.
**Monin JL, Quere JP, Monchi M, et al. Low-gradient aortic stenosis: Operative risk stratification and predictors for long-term outcome: A multicenter study using dobutamine stress hemodynamics. Circulation 2003;108:319-24. (Pubitemid 36899023)
Hachicha Z, Dumesnil JG, Bogaty P, et al. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation 2007;115:2856-64. (Pubitemid 46869673)
**Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597-607.
**Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98.
*Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: A position statement from the European association of cardio-thoracic surgery (EACTS) and the European society of cardiology (ESC), in collaboration with the European association of percutaneous cardiovascular interventions (EAPCI). Eur Heart J 2008;29:1463-70. (Pubitemid 351806497)
Moura LM, Ramos SF, Zamorano JL, et al. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis. J Am Coll Cardiol 2007;49:554-61. (Pubitemid 46177435)
Rossebo AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 2008;359:1343-56.
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;352:2389-97. (Pubitemid 40958435)
Chan KL, Teo K, Dumesnil JG, et al. Effect of lipid lowering with rosuvastatin on progression of aortic stenosis: Results of the aortic stenosis progression observation: Measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation 2010;121:306-14.