Aortic Stenosis: Pathophysiology, Diagnosis, and Therapy.

The incidence of aortic stenosis increases with age, affecting up to 10% of the population by the eighth decade. Once symptoms develop, aortic stenosis is rapidly fatal. Proper management requires an understanding of the physiology and criteria used to define disease severity. There is no effective pharmacologic treatment. Surgical aortic valve replacement has been the gold standard treatment for decades. However, over the last 10 years transcatheter aortic valve replacement has emerged as an attractive, less-invasive option for appropriately selected patients. Refinements in valve design and delivery systems have led to widespread use of this breakthrough technology in selected patients. We review the pathophysiology, criteria for valve replacement, and the results of the trials comparing transcatheter aortic valve replacement with surgical aortic valve replacement.

[1]  Philippe Ravaud,et al.  Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? , 2005, European heart journal.

[2]  A. Bogers,et al.  Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. , 2013, Journal of the American College of Cardiology.

[3]  K. Bailey,et al.  Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up , 2005, Circulation.

[4]  J. Coselli,et al.  3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. , 2016, Journal of the American College of Cardiology.

[5]  Stuart J Pocock,et al.  Transcatheter versus surgical aortic-valve replacement in high-risk patients. , 2011, The New England journal of medicine.

[6]  K. E. Werner,et al.  Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing , 2001, Heart.

[7]  Scott Lim,et al.  Two-year outcomes after transcatheter or surgical aortic-valve replacement. , 2012, The New England journal of medicine.

[8]  E. Bates.  Treatment Options in Severe Aortic Stenosis , 2011, Circulation.

[9]  Sean M. O'Brien,et al.  Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. , 2015, The Annals of thoracic surgery.

[10]  William Grossman,et al.  Cardiac catheterization and angiography , 1974 .

[11]  A. Franco‐Cereceda,et al.  Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50-69 years. , 2016, European heart journal.

[12]  L. W. Andersen,et al.  Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis: 1-Year Results From the All-Comers NOTION Randomized Clinical Trial. , 2015, Journal of the American College of Cardiology.

[13]  M. Mack,et al.  5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial , 2015, The Lancet.

[14]  M. Mack,et al.  Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. , 2016, The New England journal of medicine.

[15]  Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery , 2007 .

[16]  J. Halperin,et al.  2016 ACC Lifelong Learning Competencies for General Cardiologists: A Report of the ACC Competency Management Committee. , 2016, Journal of the American College of Cardiology.

[17]  D. Adams,et al.  Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. , 2014, JAMA.

[18]  B. Swinkels,et al.  Evaluating operative mortality of cardiac surgery: first define operative mortality , 2010, Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation.

[19]  I. Barbash,et al.  Balloon aortic valvuloplasty for severe aortic stenosis as a bridge to transcatheter/surgical aortic valve replacement , 2012, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[20]  D. Popovic,et al.  Surgical Valve Replacement (Bioprosthetic vs. Mechanical) , 2013 .

[21]  M. Davidson,et al.  Use of the Hybrid Operating Room in Cardiovascular Medicine , 2014, Circulation.

[22]  S. Hagl,et al.  Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement. , 2008, European heart journal.

[23]  J. Leipsic,et al.  Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis , 2016, The Lancet.

[24]  M. Mack,et al.  Bleeding complications after surgical aortic valve replacement compared with transcatheter aortic valve replacement: insights from the PARTNER I Trial (Placement of Aortic Transcatheter Valve). , 2014, Journal of the American College of Cardiology.

[25]  M. Dweck,et al.  Calcific aortic stenosis: a disease of the valve and the myocardium. , 2012, Journal of the American College of Cardiology.

[26]  Maurice Buchbinder,et al.  Transcatheter aortic-valve replacement with a self-expanding prosthesis. , 2014, The New England journal of medicine.

[27]  Deepak L. Bhatt,et al.  Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. , 2015, The New England journal of medicine.

[28]  R. Davidoff,et al.  Low-flow/low-gradient aortic stenosis. , 2011, Circulation.

[29]  Mary Ann Clark,et al.  Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients , 2012, Risk management and healthcare policy.

[30]  Thoralf M Sundt,et al.  2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2014, Circulation.

[31]  I. Palacios,et al.  Three‐Year Outcome After Balloon Aortic Valvuloplast: Insights Into Prognosis of Valvular Aortic Stenosis , 1994, Circulation.

[32]  Martin B Leon,et al.  Management strategies and future challenges for aortic valve disease , 2016, The Lancet.

[33]  J. Bavaria,et al.  Factors Associated With Vascular Complications in Patients Undergoing Balloon-Expandable Transfemoral Transcatheter Aortic Valve Replacement via Open Versus Percutaneous Approaches , 2014, Circulation. Cardiovascular interventions.

[34]  L. Wilkins.  Percutaneous Balloon Aortic Valvuloplasty: Acute and 30‐Day Follow‐up Results in 674 Patients From the NHLBI Balloon Valvuloplasty Registry , 1991, Circulation.

[35]  Anson Cheung,et al.  5-year outcome after transcatheter aortic valve implantation. , 2013, Journal of the American College of Cardiology.

[36]  M. Schemper,et al.  Natural History of Very Severe Aortic Stenosis , 2010, Circulation.

[37]  H. Schirmer,et al.  The evolving epidemiology of valvular aortic stenosis. The Tromsø Study , 2012, Heart.

[38]  F. Dagenais,et al.  Impact of residual regurgitation after aortic valve replacement. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[39]  M. Mack,et al.  5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial , 2015, The Lancet.

[40]  L. Cohn,et al.  Hemodynamic Determinants of Prognosis of Aortic Valve Replacement in Critical Aortic Stenosis and Advanced Congestive Heart Failure , 1980, Circulation.

[41]  P. Grayburn,et al.  Prognosis after valve replacement in patients with severe aortic stenosis and a low transvalvular pressure gradient. , 1993, Journal of the American College of Cardiology.

[42]  A. Cribier,et al.  Aortic valve replacement after percutaneous valvuloplasty--an approach in otherwise inoperable patients. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[43]  K. Lachapelle,et al.  First-in-human experience with the Medtronic CoreValve Evolut R. , 2014, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.