Management of aortic regurgitation: gaps, current evidences and future options
Prof. Thomas Senage
Edwards Lifesciences at EACTS 2022: State of the art in the treatment of aortic valve regurgitation in young patients
Prof. Ruggero De Paulis
Edwards Lifesciences at EACTS 2022: State of the art in the treatment of aortic valve regurgitation in young patients
Prof. Doenst
Edwards Lifesciences at EACTS 2022: State of the art in the treatment of aortic valve regurgitation in young patients
Prof. Ruggero De Paulis
MVT Aortic 2022, vol.1
– First and foremost, not all bicuspid aortic valves are the same
– Many post-operative measurements and goals are included within to help guide you to optimal patient outcomes
– Check out the insight provided about valve-sparing, valve repair, external annuloplasty, and more
Insights from INDURE registry
Prof. Ruggero De Paulis
Virtual Industry Symposium
Historically, survival data on patients with mild-to-moderate aortic stenosis (AS) have been limited. This situation was addressed in 2019, however, when Strange et al. published their analysis of the relationship between AS severity and mortality in a cohort of 241,303 adult patients in an observational registry. The mean age of patients at baseline was 61 years and median follow up was 1,208 days. Mild and moderate AS were found in 6.7% (n=16,129) and 1.4% (n=3,315) of patients, respectively.1
While it has been observed that severe AS is associated with poor survival, this study also suggests poor survival rates in patients with moderate AS. The five-year mortality rate for these patients was 56% (mean gradient 20.0–39.9 mmHg and/or peak velocity 3.0–3.9 m/s and/or aortic valve area greater than 1 cm²).
Mortality rates according to AS severity
The importance of early referral, regular clinical and echocardiographic surveillance and early intervention were emphasised in the recent update to the ESC/EACTS Guidelines for the management of valvular heart disease.2 In addition to recommendations for an active collaboration among Heart Team members and the inclusion of the informed patient’s preferences when determining optimal treatment, specific recommendations relevant to patients with moderate AS include:2
- Regular clinical and echocardiographic surveillance where prognosis of patients with normal-flow,
low-gradient AS and preserved ejection fraction is similar to that of moderate AS - Earlier referral if patient’s symptoms advance or worsen
- Earlier intervention to be considered in asymptomatic patients with:
- severe AS and left ventricular ejection fraction (LVEF) <55% without another cause (IIa)
- severe AS and a sustained fall in blood pressure (>20 mmHg) during exercise testing (IIa)
- LVEF >55% and a normal exercise test if the procedural risk is low and one of the following is present: very severe AS, severe valve calcification plus Vmax progression >0.3 m/s/year, or markedly elevated B-type natriuretic peptide levels without other explanation is present (IIa)2
The ESC/EACTS guidelines also support consideration of earlier intervention in select patients with asymptomatic aortic regurgitation.2
References
1. Strange G, Stewart S, Celermajer D et al. Poor long-term survival in patients with moderate aortic stenosis. JACC. 2019; 74: 1851–63.
2. Vahanian A, Beyersdorf F, Praz F et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021.
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Dr. Vinod Thourani
Be courageous, be experienced, be ethical … according to the Guidelines!
Prof. Bart Meuris
Be courageous, be experienced, be ethical … according to the Guidelines!
Dr. Alison Duncan
Be courageous, be experienced, be ethical … according to the Guidelines!
Prof. Michael Borger
Be courageous, be experienced, be ethical … according to the Guidelines!
Prof. Ruggero De Paulis
MVT Aortic 2021
Prof. Stephan Ensminger
MVT Aortic 2021
Jean-Louis Vanoverschelde, Belgium
What to know in 2020
