Materiały źródłowe

• #1 Current Therapeutic Options in Aortic Stenosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33914604/

  Aortic stenosis is the most common valvular disease requiring valve replacement. […] Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. […] This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.

• #1 Aortic valve stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145

  Treatment for aortic valve stenosis depends on the symptoms and how severe the condition is. Aortic valve stenosis ranges from mild to severe. […] If you have no symptoms or just mild ones, you may only need regular health checkups. Some people need medicines to treat valve disease symptoms or reduce the risk of complications. […] Other treatments for aortic valve disease may include: Heart-healthy lifestyle changes. Eat healthy, get regular exercise and stay active, and do not smoke. Medicines to treat symptoms or reduce the risk of complications. Surgery to fix or replace the valve. […] Some people with aortic valve stenosis may need medicines to treat symptoms or reduce the risk of complications. For example, medicines may be used to: Lower blood pressure. Prevent irregular heartbeats. Remove excess fluid from the body to reduce the strain on the heart.

• #1 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is also indicated in asymptomatic patients with severe or even moderate stenosis who are undergoing cardiac surgery for other indications; this avoids the need for repeat surgery once the valve disease inevitably progresses. […] Watchful waiting is recommended for most asymptomatic patients with aortic stenosis, including those with severe disease. […] Surgical aortic valve replacement is the standard of care in patients with low or intermediate surgical risk. […] Transcatheter aortic valve replacement is recommended for patients who have an indication for valve replacement but are at prohibitive surgical risk.

• #1 Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7729185/

  A crucial aspect regarding the medical treatment of symptomatic SAS is that almost all cardiovascular drugs should be used with caution due to the possibility of iatrogenic hypotension and syncope. […] ACEI and ARB are very useful in the treatment of arterial hypertension and systolic heart failure in the general population. Still, their use in patients with SAS should be carefully monitored because of the risk of hypotension and syncope. However, there is experimental and clinical evidence that ACEI and ARB prevent the hemodynamic impairment of aortic stenosis. Nevertheless, most of these studies included patients with moderate aortic stenosis and normal left ventricular ejection fraction (LVEF). […] Calcium channel blockers should be used with caution because of the risk of hypotension and aggravation of heart failure. Diuretics must be used with caution because patients with SAS are preload-dependent, and they can develop a low cardiac output and arterial hypotension with peripheral hypoperfusion.

• #1 Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7729185/

  Beta-blockers are difficult to manage in patients with SAS because of the risk of negative inotropic effect in the presence of left ventricular outflow tract obstruction. They are not indicated in symptomatic SAS with heart failure but can be used in low doses in patients with atrial fibrillation for rate control or in hypertension. […] Emergency balloon aortic dilatation can be performed instead of TAVI, but preferably as a bridge therapy before TAVI. […] In conclusion, medical treatment in patients with symptomatic SAS who, for various reasons, cannot undergo the recommended aortic valve replacement is a difficult decision, and the outcomes are inferior to invasive procedures.

• #1 Aortic Stenosis: Causes, Symptoms, Treatments

  https://www.medicinenet.com/aortic_stenosis/article.htm

  What is the treatment for aortic stenosis? Patients without symptoms can be observed until symptoms develop. Patients with mild aortic stenosis do not require treatment or restriction of activity. Patients with moderate aortic stenosis (valve area 1.5 to 1.0 square centimeters) are advised to avoid strenuous activities such as weight lifting or sprinting. Aortic stenosis can progress over a few years. Therefore, patients are usually examined annually and evaluated by echocardiography periodically to monitor disease progression. Since valve infection (endocarditis) is a serious complication of aortic stenosis, these patients are usually given antibiotics before any procedure in which bacteria may be introduced into the bloodstream. This includes routine dental work, minor surgery, and procedures that may traumatize body tissues such as colonoscopy and gynecologic or urologic examinations. Examples of antibiotics used include oral amoxicillin (Amoxil) and erythromycin (E-Mycin, Eryc, PCE), as well as intramuscular or intravenous ampicillin (Unasyn), gentamicin (Garamycin), and vancomycin (Lyphocin, Vancocin).

• #1 Aortic valve stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145

  Surgery to repair or replace an aortic valve is usually done through a cut in the chest. Less invasive approaches may be available. Ask your healthcare professional which type of aortic valve treatment is best for you. […] Surgery and procedures for aortic valve stenosis include: Balloon valvuloplasty. This treatment helps open a narrowed valve. It may be done in infants and children with aortic valve stenosis. In adults, the aortic valve tends to narrow again after the treatment. So it’s usually done only if an adult is too sick for surgery or if an adult is waiting for a valve replacement. […] Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, the surgeon takes out the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue.

• #1 Treatment of Aortic Stenosis | Hope For Hearts New Zealand

  https://www.hopeforhearts.nz/aortic-stenosis/treatment/

  The primary treatment of aortic stenosis is replacement of the damaged aortic valve. […] Transcatheter aortic valve implantation (TAVI) is a treatment option for aortic stenosis patients. […] TAVI is usually performed in a Cardiac Catheter Laboratory and utilises a minimally invasive approach to replace the diseased aortic valve. […] Balloon Aortic Valvuloplasty (BAV) has been used as a temporary treatment for aortic stenosis. This procedure is usually performed in a Cardiac Catheter Lab and involves the introduction of a balloon into the diseased aortic valve, the balloon is inflated and then deflated, then removed. […] Despite temporarily relieving patient symptoms, restenosis often returns as diseased valve returns to its pre-procedure state. The frequent return of AS symptoms confirm the palliative nature of this treatment option.

• #1 Aortic Stenosis: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-stenosis/treatment

  Aortic valve stenosis treatment will depend on your symptoms and the severity of the condition. Your cardiology team will work closely with you to determine the best course of action based on your overall health and risk factors. In some cases, you can get aortic valve stenosis treatment without surgery. If you have mild aortic stenosis, treatment may be handled through medications or other nonsurgical methods. […] As part of your care treatment for aortic stenosis, medications may be administered to alleviate symptoms such as chest pain and shortness of breath. These drugs include beta-blockers and calcium channel blockers or diuretics. Your physician may also recommend ACE inhibitors to control blood pressure, anticoagulants to prevent blood clots, and antibiotics to fight infections. […] Surgery is sometimes necessary for severe aortic valve stenosis treatment. If your condition significantly impairs your heart function, your physician may recommend one of the following surgical procedures: Aortic valve replacement (AVR): AVR is a common treatment for severe aortic stenosis. During this open-heart procedure, the surgeon removes the damaged aortic valve and replaces it with a prosthetic valve. Prosthetic options include mechanical valves or valves made from human, cow, or pig tissue.

• #1 Treatment options for severe Aortic Stenosis: Deciding between surgery and TAVI – South Tees Hospitals NHS Foundation Trust

  https://www.southtees.nhs.uk/resources/treatment-options-for-severe-aortic-stenosis-deciding-between-surgery-and-tavi/

  TAVI is a procedure where a new valve is placed in the heart through a small tube usually at the top of the leg. It involves numbing the area and making a small cut where the tube is inserted to access the heart and place the new valve. TAVI is usually performed while you are awake (local anaesthetic) with sedation if required. […] SAVR is open heart surgery where a new valve is placed in the heart directly. It involves a cut along the breastbone to access the heart to replace the valve. SAVR is performed whilst asleep (general anaesthetic). […] Both procedures are effective options for treating your aortic valve. Either treatment will help you live longer and feel better. […] We understand that you might want to take some time to talk this over with your family or friends. If you have further questions then you can ask them at your appointment, please use the space on the next page to write down any questions you might have.

• #1 Aortic Stenosis: Causes, Symptoms, Treatments

  https://www.medicinenet.com/aortic_stenosis/article.htm

  Mechanical prostheses have proven to be extremely durable and can be expected to last from 20 to 40 years. However, mechanical prosthetic valves all require life-long anticoagulation with blood thinners such as warfarin (Coumadin) to prevent clot formation on the valve surfaces. Otherwise, blood clots dislodged from these valves can travel to the brain and cause embolic stroke or embolic problems in other parts of the body. The original caged-ball Starr-Edwards prosthesis of the 1960s was replaced by the tilting disc Bjork-Shiley of the 1970s and early 1980s. Although the Bjork-Shiley valve provided a larger opening for blood flow, a second-generation model of the valve posed the risk of potential breakage resulting in death and is no longer available in the United States. The tilting pivoting disc Hall-Medtronic valve and the two leaflet (bileaflet) carbon St. Jude valve is commonly used mechanical prostheses today. These valves provide excellent flow characteristics but require life-long anticoagulation with blood thinners such as warfarin (Coumadin), to prevent embolic complications.

• #1 Aortic Stenosis: Causes, Symptoms, Treatments

  https://www.medicinenet.com/aortic_stenosis/article.htm

  When symptoms of chest pain, syncope, or shortness of breath appear, the prognosis for patients with aortic stenosis without valve replacement surgery is poor. Medical therapy, such as the use of diuretics to reduce high lung pressures and remove lung fluid can provide only temporary relief of symptoms. Patients with symptoms usually undergo cardiac catheterization. If severe aortic stenosis is confirmed, aortic valve replacement is usually recommended. The overall mortality risk for aortic valve replacement surgery is about 5%. Advanced age should not be a reason for not recommending aortic valve replacement for aortic stenosis. Otherwise healthy patients in their 80s with strong heart muscles often benefit dramatically from aortic valve replacement for critical aortic stenosis. […] Replacement aortic valves processed from pigs (porcine) or cows (bovine) are called bioprostheses. Bioprostheses are less durable than mechanical prostheses (discussed below) but have the advantage of not needing life-long blood thinning (anticoagulation) medication to prevent blood clots from forming on the valve surfaces. The average life expectancy of an aortic valve bioprosthesis is 10 to 15 years. Bioprostheses rapidly calcify, degenerate and narrow in young patients. Therefore, bioprostheses are primarily used on older patients or in patients who cannot take blood thinners. Recently, aortic valves from human cadavers have been used in younger patients to avoid the need for anticoagulation medication. However, the availability of human aortic grafts is limited; though probably better than the other bioprostheses, their long-term durability is unknown. The new „Ross Procedure” consists of moving the pulmonic valve to the aortic position and replacing the pulmonic valve with a valve from a human donor. This procedure has not been performed long enough to evaluate the long-term performance of the pulmonic valve when moved to the aortic position.

• #1 Aortic valve stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145

  Sometimes, the aortic valve is replaced with the person’s own lung valve, called the pulmonary valve. The pulmonary valve is replaced with a biological lung tissue valve from a deceased donor. This more complicated surgery is called the Ross procedure. […] Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves need to take blood thinners for life to prevent blood clots. Talk with your healthcare team about the benefits and risks of each type of valve. […] TAVR is an option to open-heart valve surgery. It uses small cuts and a thin, flexible tube called a catheter to replace the aortic valve. During TAVR, a surgeon replaces a narrowed aortic valve with a valve made of cow or pig tissue. TAVR may be an option if you’re at intermediate or high risk of complications from surgical aortic valve replacement.

• #1 Managing Aortic Stenosis Symptoms    | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptoms

  After general anesthesia is administered, a cardiothoracic surgeon makes an incision in the chest. Once the patient is placed on the heart-lung machine, the heart is opened and the diseased valve is removed. A new valve is then sewn into place. Following SAVR, patients are discharged in about one week from the hospital. […] Once it has been determined that your aortic valve needs to be replaced, your doctor will discuss treatment options to help you decide which valve replacement procedure is best for you. This discussion will include the risks and benefits of each procedure. Whichever procedure you choose, lifetime follow-up with a cardiologist is necessary to ensure that your replacement valve continues to function well over time.

• #1 Aortic valve stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145

  During TAVR, the surgeon places a tube into a blood vessel and guides it to the heart. A replacement valve made of cow or pig tissue goes through the tube to the aortic valve area. A balloon on the tube’s tip inflates to press the new valve into place. Some valves can self-expand. […] Surgeons may fix the aortic valve by separating valve flaps that are stuck together. However, valve repair is rarely used to treat aortic valve stenosis. Generally aortic valve stenosis requires aortic valve replacement.

• #1 Managing Aortic Stenosis Symptoms    | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptoms

  Severe AS, sometimes referred to as a failing heart valve, is a life-threatening condition. The treatment for severe AS is aortic valve replacement. This is accomplished either through the open-heart surgery SAVR (surgical aortic valve replacement) or the less invasive procedure called TAVI or TAVR (transcatheter aortic valve implantation or transcatheter aortic valve replacement). Although SAVR has traditionally been the standard for treating severe AS, TAVI is now available to most patients. […] After aortic valve replacement, you can expect your symptoms to resolve and to have an improved quality of life. […] During a TAVI procedure, an interventional cardiologist inserts a replacement valve through an artery in the groin or chest area. The new valve is guided through the artery into the heart to the position of the diseased aortic valve. Once in place, a balloon is expanded, and the new valve becomes implanted. TAVI may be performed with sedation or general anesthesia. Patients are often discharged from the hospital within a few days. Time in the hospital following TAVI is dependent on many factors, including age and the presence of other medical conditions.

• #1 The past, present and future of aortic stenosis treatment

  https://bjcardio.co.uk/2023/03/the-past-present-and-future-of-aortic-stenosis-treatment/

  The latest iteration of the European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines for the management of valvular heart disease includes expanded indications for earlier intervention in patients with asymptomatic AS and a number of revised Class I recommendations regarding the mode of intervention in AS (primarily based on age thresholds rather than surgical risk scores). Importantly, the guidelines emphasise the critical role of the Heart Team in coordinating AS treatment and the importance of including the values and preferences of the patient (and their family) in the decision-making process. […] Since its introduction for the treatment of patients with inoperable AS, use of TAVI has steadily expanded to high-, intermediate- and low-risk patient populations, driven by a wealth of clinical evidence. Developments in TAVI over the last 10 years have resulted in improved patient survival and lower complication rates that match or improve on those seen with SAVR, and reduced impact on hospital resources. Based on Class IA evidence, the ESC/EACTS guidelines recommend transfemoral TAVI as the standard of care for patients aged 75 years and over. These guidelines emphasise the need for a Heart Team assessment to balance clinical evidence and patient perspectives to ensure an individualised treatment choice.

• #1 Current Strategies in the Management of Aortic Stenosis | USC Journal

  https://www.uscjournal.com/articles/final-word-current-strategies-lifetime-management-patients-aortic-valve-stenosis?language_content_entity=en

  Aortic valve stenosis (AS) is the most common form of valvular heart disease in developed countries, with a prevalence that increases exponentially with advancing age. […] In addition to medical therapy, aortic valve replacement is often needed to limit disease progression, improve prognosis, and enhance the quality of life. Historically, surgical aortic valve replacement (SAVR) has been the mainstay therapy in most patients, while transcatheter aortic valve replacement (TAVR) has been limited to those at high risk for surgery. […] Clinical guidelines provide no recommendations for the pharmacological treatment of AS beyond symptomatic relief and control of concomitant hypertension. […] Class 1 indications for aortic valve replacement are: Severe AS with symptoms of exertional dyspnea, angina, or heart failure. Severe AS, asymptomatic, but with left ventricular ejection fraction 50%. Severe AS, asymptomatic, but undergoing cardiac surgery for other indications.

• #1 Aortic Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/treatment

  According to the ACC/AHA Guidelines, AVR is indicated for all patients with Stage D disease and patients with Stage C disease that either have a reduced LVEF ( 50%) or are undergoing surgery for another cardiac condition. Although surgical AVR (SAVR) is the default option, TAVR is appropriate for patients with prohibitive surgical risk. TAVR may also be considered as an alternative to SAVR in patients receiving bioprosthetic (but not mechanical) valves. However, because of limited data on TAVR durability, SAVR is preferred in patients with longer life expectancy, and the choice of procedure should be individualized according to patient-specific factors, including comorbidities, anatomical amenability and preferences. […] In patients with Stage C disease and a normal LVEF, the ACC/AHA Guidelines state that SAVR is reasonable (but necessarily indicated) if the patients exercise capacity and blood pressure decrease during an exercise treadmill test, or if the patient has low surgical risk and fulfils one of the following criteria: 1) transaortic Vmax of 5 m/s or greater; 2) B-type natriuretic peptide elevation of 3X normal; or 3) rapid disease progression. SAVR may be considered (class 2b recommendation) in patients with Stage C aortic stenosis with a progressive decrease in LVEF (to 60%) on at least 3 serial imaging studies, or in patients with Stage B (moderate) disease who are undergoing cardiac surgery for another indication.

• #1 Current Strategies in the Management of Aortic Stenosis | USC Journal

  https://www.uscjournal.com/articles/final-word-current-strategies-lifetime-management-patients-aortic-valve-stenosis?language_content_entity=en

  In general, symptomatic patients who undergo aortic valve replacement have a better prognosis, enhanced quality of life, and improved left ventricular systolic function. […] The ideal timing of aortic valve replacement should be determined while considering several factors. […] The choice between SAVR and TAVR must be based upon careful evaluation of clinical, anatomical, and procedural factors by the Heart Team, weighing the risks and benefits of each approach for an individual patient. […] Early clinical trials have established TAVR as the best option for treating patients with symptomatic severe AS who are deemed to be at moderate-to-high operative risk, and who cannot otherwise undergo surgical replacement. […] In summary, the results from these two ground-breaking trials inform us that TAVR is superior to SAVR in the short term among low-risk patients with AS. […] AS remains the leading etiology of valvular heart diseases requiring intervention in addition to medical therapy in developed countries. Over the past 20 years, multiple innovations have improved the safety and efficacy of invasive treatments for AS, with TAVR being the most notable invention.

• #1 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Current guidelines reflect the published literature up to 2017 and include the results of trials comparing TAVI and AVR in intermediate-risk patients, but not the more recent studies in low-risk cohorts. […] The evidence supporting the current recommendations is limited for TAVI in patients aged 75 years and for low-risk patients, and there remain concerns about the durability of TAVI valves. […] In general, TAVI is associated with higher rates of vascular injury, pacemaker implantation, and paravalvular regurgitation, whereas AVR carries greater risks of major bleeding, acute kidney injury, and new-onset atrial fibrillation. […] TAVI is recommended for patients judged unsuitable for AVR by the Heart Valve Team (Class I), in particular, patients at higher surgical risk (STS-PROM score or EuroSCORE II 4% [logistic EuroSCORE I 10%]) or with other risk factors listed above, especially elderly patients with suitable access for transfemoral TAVI.

• #1 Cardiologist Q&A: Aortic Stenosis Symptoms, Risks & Treatment

  https://www.heart-valve-surgery.com/learning/aortic-valve-stenosis-symptoms-risks-treatment/

  TAVR has unique advantages compared to surgical approaches. Dr. Aneja said, “There are several advantages over the surgical approach. There’s no cutting of the sternum (chest), so patients don’t have to go through a heart-lung machine or bypass. Sometimes, they don’t even have to have general anesthesia, and it can be done with local anesthesia and modern sedation approaches. Patients often go home the next day.” […] TAVR has transformed the treatment of aortic stenosis. Dr. Aneja stated, “TAVR has absolutely transformed the treatment of aortic stenosis. We have seen patients who were previously reluctant to have any kind of surgical approaches do wonderfully after TAVR. They get their quality of life back almost immediately.” […] My advice to aortic stenosis patients is that you establish (connect) with a program that has an active TAVR heart team that takes care of these complicated individuals. Make sure to follow up with them regularly with echocardiograms and clinical visits, and when the time comes, be ready for this procedure.

• #1 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Finally, balloon valvuloplasty may be considered as a bridge to surgery or TAVI in unstable patients (or in patients with symptomatic severe aortic stenosis needing urgent major non-cardiac surgery), or diagnostically in patients with comorbidities to help to define the contribution of aortic stenosis to symptoms or organ dysfunction (Class IIb). […] The best modality of intervention depends upon the patients age, comorbidities, and anatomical and technical factors. […] TAVI is non-inferior to surgical AVR in intermediate-risk patients with respect to death and disabling stroke, and even superior when transfemoral access is possible; the latest studies suggest that TAVI may even be superior to surgical AVR for selected intermediate- and low-risk cases, but these studies had important exclusion criteria limiting the wider applicability of these findings, and long-term TAVI durability data are lacking.

• #1 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Minimally invasive AVR and the use of rapid-deployment or resilient valves have the potential to reduce the morbidity of surgical AVR, and mechanical valves needing lower-intensity anticoagulation have reduced some of the long-term risks of mechanical AVR, making this more attractive in individual cases.

• #1 Study Suggests Focused Ultrasound Treatment of Aortic Valve Stenosis Safe, Stroke-Free – Focused Ultrasound Foundation

  https://www.fusfoundation.org/posts/study-suggests-focused-ultrasound-treatment-of-aortic-valve-stenosis-safe-stroke-free/

  Investigators have published initial safety data from a first-in-human study to treat calcific aortic stenosis. […] Cardiawave’s Valvosoft® device uses focused ultrasound to nonthermally soften a calcified aortic valve. […] Post-procedure MRIs revealed no acute ischemic changes, major adverse events, or signs of stroke. […] The Valvosoft® technology is designed as a treatment option for the approximately 16% of patients with CAS who do not qualify for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) due to comorbidities or the risk of procedural complications (e.g., stroke). […] Valvosoft® uses focused ultrasound to create pulsed cavitation (a bubble cloud) that mechanically and nonthermally softens the heart valve by cracking calcium buildup inside the valve leaflets.

• #1 Modern Treatment for Aortic Valve Stenosis Video , Watch Here

  https://www.thekeyholeheartclinic.com/blog/modern-treatment-for-aortic-valve-stenosis-video/

  Aortic valve stenosis can treated without breaking the breastbone in nearly every case using minimally invasive (keyhole) heart surgery. Surgery remains the main stay of treatment and is highly successful. Keyhole heart surgeons can perform aortic valve replacement through tiny cuts which heal in days rather than months. […] For some patients, who are not suitable for surgery, a heart valve can be inserted through the groin without any incisions at all using a procedure called TAVI ( or TAVR).

• #1

  https://www.treattheheart.com/en-US/tavr-resources/frequently-asked-questions/severe-aortic-stenosis-faqs.html

  Aortic stenosis is a progressive disease that typically, but not always, worsen over time. […] Your TAVR procedure will restore the normal flow of blood immediately. […] Depending upon the type of replacement valve you have, your heart team will let you know what, if any, medications are required. […] Historically, biologic valves usually needed to be re-replaced after around 10 years. Mechanical valves are designed to work just like your natural valve and are made of carbon or metal. They are made to last a lifetime and considered very durable.

• #1 Aortic Stenosis (Aortic Valve Disease): Types, Symptoms, & Causes | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/programs/aortic-disease/aortic-stenosis

  Treatment for aortic stenosis can include: […] Preventive lifestyle adjustments, such as reducing strenuous activities or limiting physical activity for patients with mild aortic stenosis. […] Aortic valve repair or valve replacement, which may involve open heart surgery or transcatheter aortic valve replacement. […] Another option for some patients is transcatheter aortic valve replacement (TAVR). This is less invasive than the traditional open-heart surgery to replace the aortic valve, but we dont recommend it for every patient. […] We will help you and your doctors decide on a treatment plan depending on how severe your aortic stenosis is. […] Studies have shown that undergoing a valve replacement procedure for aortic stenosis is an effective treatment method, and that following surgery, patients over the age of 65 have only a slightly lower life expectancy than someone who have the condition at all. The surgery was also shown to reduce the risk of stroke. […] Patients with moderate to severe aortic stenosis may need surgery to repair or replace the aortic valve.

• #1 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Aortic valve intervention is indicated for symptomatic aortic stenosis (studies are ongoing into asymptomatic severe disease). […] The best choice for intervention for aortic stenosis in an individual patient has become increasingly complex because of technological advances minimal access surgery, rapid-deployment valves, resilient valves, and later-generation transcatheter aortic valve implantation (TAVI) devices and the extrapolation of clinical trial results beyond carefully defined study cohorts. […] Cases should be discussed by a Heart Valve Team after detailed clinical assessment to recommend the best approach full sternotomy or minimal access surgery, or catheter-based intervention according to the best available clinical evidence and the patients preference. […] Early intervention is recommended for severe high-gradient aortic stenosis (mean transaortic gradient 40 mmHg or peak velocity 4 m/s, Class I recommendation) and severe low-flow, low-gradient aortic stenosis (40 mmHg) with reduced ejection fraction and either evidence of contractile reserve (Class I) or with severe aortic stenosis confirmed on computed tomography (CT) calcium scoring (Class IIa).

• #1

  https://www.treattheheart.com/en-US/tavr-resources/frequently-asked-questions/severe-aortic-stenosis-faqs.html

  Transcatheter Heart Valve Replacement (TAVR) and Transcatheter Heart Valve Implantation (TAVI) are two different names for the exact same procedure. […] Clinical trials have demonstrated that TAVR is safe and effective. Of course, there are risks associated with all medical procedures. Be sure to talk with your doctor so that you thoroughly understand all the risks associated with transcatheter aortic valve replacement. […] Replacing the aortic valve is the only effective treatment for stenosis. Without the benefit of a replacement valve, up to 50% of people who develop severe aortic stenosis symptoms will die within an average of two years. […] Replacing the aortic valve is the only effective treatment for severe aortic stenosis. Being a candidate for TAVR requires your condition to meet specific medical criteria.

• #2 The past, present and future of aortic stenosis treatment

  https://bjcardio.co.uk/2023/03/the-past-present-and-future-of-aortic-stenosis-treatment/

  Open-heart surgery for AS was introduced in 1913 and the first surgical aortic valve replacement (SAVR) was performed in the early 1960s using a caged-ball prosthesis. Since then, surgery has evolved towards less invasive approaches (mini-sternotomy or mini-thoracotomy) to reduce tissue trauma, and the use of minimal extracorporeal circulation to reduce the inflammatory effects of cardiopulmonary bypass. Until the 1980s, SAVR was the only effective treatment option for patients with AS, although many of those aged 70 years were considered too high risk for surgery and remained untreated. In 1985, Alain Cribier developed the first catheter-based approach for the treatment of AS balloon aortic valvuloplasty which provided early improvement in quality of life for inoperable patients but was steadily discarded due to high rates of restenosis. Following successful development in pre-clinical models, the first-in-human transcatheter aortic valve implantation (TAVI) was conducted by Cribier and colleagues in Rouen in 2002. Despite early pushback from the medical community, this ground-breaking achievement triggered a revolution in the treatment of AS and opened the field for transcatheter treatment of mitral, tricuspid and pulmonary valve disease.

• #2 Aortic stenosis – UF Health

  https://ufhealth.org/conditions-and-treatments/aortic-stenosis

  Regular checkups by a provider may be all that is needed if your symptoms are not severe. The provider should ask about your health history, do a physical exam, and perform an echocardiogram. […] People with severe aortic stenosis may be told not to play competitive sports, even if they have no symptoms. If symptoms do occur, strenuous activity must often be limited. […] Medicines are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated. If aortic stenosis is severe, this treatment must be done carefully so blood pressure does not drop too far. […] Surgery to repair or replace the valve is often done for adults or children who develop symptoms. Even if symptoms are not very bad, the provider may recommend surgery based on test results.

• #2 Aortic Valve Stenosis: Symptoms, Causes, Risk factors, Diagnosis & Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/aortic-valve-stenosis

  Regular health checkups and lifestyle changes may be sufficient for mild aortic stenosis. However, in severe cases, aortic valve replacement or repair is necessary. If left untreated, it can lead to death. […] The treatment modality depends on the severity of the condition and its symptoms. Those with mild symptoms may merely need regular checkups, lifestyle changes, medications, and regular echocardiography every 6-12 months.

• #2 Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7729185/

  There is no specific medical treatment for symptomatic SAS in this situation. The drugs used for heart failure, arrhythmia, ischemic heart disease, and other comorbidities are the same as in other patients. Still, many precautions need to be taken due to hemodynamic instability in such patients. […] The medical management of patients with symptomatic SAS begins with some lifestyle changes and general care: (1) patients should limit their physical activity, in case they do not already have a sedentary life because of frailty or comorbidities; (2) sodium intake should be restricted to 2 g/day; (3) doctors should review patients’ current medication to avoid hypotension and dehydration, knowing the patient is „afterload fixed and preload dependent”; (4) hyperhydration should be avoided because of the risk of acute heart failure; (5) according to recent guidelines, endocarditis prophylaxis is indicated only in patients with a previous history of infectious endocarditis; and (6) patients should be evaluated for coronary heart disease and should receive appropriate medication.

• #2 Aortic Stenosis Medication: Beta-Adrenergic Receptor Blockers, Cardiac Glycoside, Loop Diuretics, Angiotensin-converting Enzyme (ace) Inhibitor, Opioid Analgesics

  https://emedicine.medscape.com/article/150638-medication

  Treatment of valvular aortic stenosis is interventional. Medical treatment in aortic stenosis essentially is reserved for patients who have complications of the disorder, such as heart failure, infective endocarditis, hypertension, or arrhythmias. […] The medical treatment options are limited in symptomatic patients with aortic stenosis who are not candidates for surgery. In patients with pulmonary congestion, cautious use of digitalis, diuretics, and angiotensin-converting enzyme (ACE) inhibitors might be attempted, whereas beta-blockers might be used if the predominant symptom is angina. […] Beta-blockers may be used if the predominant symptom is angina. […] Cardiac glycosides slow AV nodal conduction primarily by increasing vagal tone. Patients with aortic stenosis who are not candidates for surgery and present with pulmonary congestion may be treated with digoxin.

• #2 Aortic stenosis – UF Health

  https://ufhealth.org/conditions-and-treatments/aortic-stenosis

  A less invasive procedure called balloon valvuloplasty may be done instead of or before surgery. […] A newer procedure done at the same time as valvuloplasty can implant an artificial valve (transcatheter aortic valve replacement or TAVR). This procedure is becoming more common. […] Some children may need aortic valve repair or replacement. Children with mild aortic stenosis may be able to take part in most activities.

• #2 Aortic Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-stenosis/treatment

  The only effective treatment for aortic stenosis is relief of the mechanical obstruction. To date, only aortic valve replacement (AVR) has been shown to achieve this while reducing mortality. […] In adults with aortic stenosis undergoing balloon valvuloplasty, severe aortic stenosis returns at 6 months in about 50% of cases. Furthermore, valvuloplasty does not result in regression of left ventricular hypertrophy. In fact, in about 50% of patients, the aortic valve re-stenoses to pre-valvuloplasty levels 6 months after the procedure. In addition, long term studies have shown that the overall mortality of patients who underwent a valvuloplasty for aortic stenosis is not different from that of patients who did not. The procedural mortality rate is 2-5%, similar to that of surgical AVR. Aortic balloon valvuloplasty is appropriate in congenital aortic stenosis where no calcification of the aortic valve has occurred. However, this modality is not effective for aortic stenosis accompanied by significant calcification.

• #2 Aortic valve stenosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145

  In a biological valve replacement, a valve made from cow, pig or human heart tissue replaces the damaged heart valve. […] In a mechanical valve replacement, an artificial heart valve made of strong material replaces the damaged valve. […] Transcatheter aortic valve replacement (TAVR) is a type of heart valve surgery. It’s done to replace a narrowed aortic valve, a condition called aortic valve stenosis. A doctor inserts a flexible tube called a catheter into a blood vessel and guides it into the heart. A replacement valve made of cow or pig tissue goes through the tube to the specific area in the heart. A balloon on the catheter tip inflates to press the new valve into place. Some valves are self-expanding. […] You may eventually need a surgery to repair or replace the narrowed aortic valve, even if you don’t have symptoms. Aortic valve surgery may be done at the same time as other types of heart surgery.

• #2 Aortic Stenosis | Innovative Aortic Valve Replacement Techniques near Cleveland, Ohio| University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/heart-valve-disease/aortic-stenosis

  Your surgeon will remove the damaged aortic valve and replace it with a valve made from biological heart tissue from a human, cow or pig. Biological tissue valves may break down over time though, so depending on your condition, your surgeon may recommend a mechanical valve instead. Patients with mechanical valves need to take blood thinners for life to prevent blood clots. […] Through research and innovation, a nonsurgical approach called transcatheter aortic valve replacement (TAVR) was developed. A small incision is made in the leg to insert a long, thin tube (catheter), threading it up to the damaged aortic valve and replacing it with a new valve. […] The Ross procedure is an aortic valve replacement surgery for patients who have aortic stenosis or certain other types of aortic valve disease. In the procedure, a surgeon removes the diseased or damaged aortic valve and replaces it with the patients own pulmonary valve. The patients pulmonary valve is replaced with a donor pulmonary valve. Suitable for patients of a wide age range from infants to active adults aged 60 or younger the Ross procedure has an excellent success rate in restoring normal life expectancy to people with severe aortic valve disease.

• #2 Aortic Valve Stenosis Symptoms, Causes & Treatments | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/aortic-valve-stenosis

  Sometimes, aortic valve replacement must be done through traditional open surgery. During open surgery, the diseased aortic valve is replaced with a valve made from man-made materials or from animal or human tissue. […] Recovery depends upon how your body heals and the type of surgery. After open surgery, you will be in the hospital for up to 10 days and it may be three to six months before you feel able to fully resume normal activities. After TAVR, you will be in the hospital for a few days and it may be four to six weeks before full recovery.

• #2 Managing Aortic Stenosis Symptoms    | American Heart Association

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptoms

  Severe AS, sometimes referred to as a failing heart valve, is a life-threatening condition. The treatment for severe AS is aortic valve replacement. This is accomplished either through the open-heart surgery SAVR (surgical aortic valve replacement) or the less invasive procedure called TAVI or TAVR (transcatheter aortic valve implantation or transcatheter aortic valve replacement). Although SAVR has traditionally been the standard for treating severe AS, TAVI is now available to most patients. […] After aortic valve replacement, you can expect your symptoms to resolve and to have an improved quality of life. […] During a TAVI procedure, an interventional cardiologist inserts a replacement valve through an artery in the groin or chest area. The new valve is guided through the artery into the heart to the position of the diseased aortic valve. Once in place, a balloon is expanded, and the new valve becomes implanted. TAVI may be performed with sedation or general anesthesia. Patients are often discharged from the hospital within a few days. Time in the hospital following TAVI is dependent on many factors, including age and the presence of other medical conditions.

• #2 Current Strategies in the Management of Aortic Stenosis | USC Journal

  https://www.uscjournal.com/articles/final-word-current-strategies-lifetime-management-patients-aortic-valve-stenosis?language_content_entity=en

  In general, symptomatic patients who undergo aortic valve replacement have a better prognosis, enhanced quality of life, and improved left ventricular systolic function. […] The ideal timing of aortic valve replacement should be determined while considering several factors. […] The choice between SAVR and TAVR must be based upon careful evaluation of clinical, anatomical, and procedural factors by the Heart Team, weighing the risks and benefits of each approach for an individual patient. […] Early clinical trials have established TAVR as the best option for treating patients with symptomatic severe AS who are deemed to be at moderate-to-high operative risk, and who cannot otherwise undergo surgical replacement. […] In summary, the results from these two ground-breaking trials inform us that TAVR is superior to SAVR in the short term among low-risk patients with AS. […] AS remains the leading etiology of valvular heart diseases requiring intervention in addition to medical therapy in developed countries. Over the past 20 years, multiple innovations have improved the safety and efficacy of invasive treatments for AS, with TAVR being the most notable invention.

• #2 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. […] Watchful waiting is recommended for most asymptomatic patients. However, select patients may also benefit from aortic valve replacement before the onset of symptoms. […] Surgical valve replacement is the standard of care for patients at low to moderate surgical risk. […] Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk. […] Aortic valve replacement is the only effective treatment for symptomatic, hemodynamically severe aortic stenosis. […] Aortic valve replacement is also recommended for asymptomatic patients with severe stenosis accompanied by LV systolic dysfunction (EF less than 50%).

• #2 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Finally, balloon valvuloplasty may be considered as a bridge to surgery or TAVI in unstable patients (or in patients with symptomatic severe aortic stenosis needing urgent major non-cardiac surgery), or diagnostically in patients with comorbidities to help to define the contribution of aortic stenosis to symptoms or organ dysfunction (Class IIb). […] The best modality of intervention depends upon the patients age, comorbidities, and anatomical and technical factors. […] TAVI is non-inferior to surgical AVR in intermediate-risk patients with respect to death and disabling stroke, and even superior when transfemoral access is possible; the latest studies suggest that TAVI may even be superior to surgical AVR for selected intermediate- and low-risk cases, but these studies had important exclusion criteria limiting the wider applicability of these findings, and long-term TAVI durability data are lacking.

• #2 TAVR: Minimally Invasive Aortic Valve Stenosis Treatment | Temple Health

  https://www.templehealth.org/about/blog/tavr-less-invasive-treatment-for-aortic-valve-stenosis

  If you or a loved one is living with aortic stenosis, or the narrowing of the aortic valve in the heart, you may be recommended for a procedure to replace your existing stenotic valve. The good news is there is a minimally invasive option called transcatheter aortic valve replacement (TAVR). […] TAVR is a minimally invasive procedure used to treat aortic valve stenosis without major surgery. […] The TAVR procedure uses a thin, flexible tube called a catheter to replace the damaged aortic valve. […] One of the advantages of TAVR is the short recovery time. […] Most patients begin a cardiac rehabilitation program within several days of having TAVR. […] I typically recommend TAVR to patients with severe aortic stenosis that causes symptoms such as chest pain, fatigue, fainting, or shortness of breath.

• #2 Intervention for symptomatic severe aortic stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/intervention-for-symptomatic-severe-aortic-stenosis

  Minimally invasive AVR and the use of rapid-deployment or resilient valves have the potential to reduce the morbidity of surgical AVR, and mechanical valves needing lower-intensity anticoagulation have reduced some of the long-term risks of mechanical AVR, making this more attractive in individual cases.

• #2 Study Suggests Focused Ultrasound Treatment of Aortic Valve Stenosis Safe, Stroke-Free – Focused Ultrasound Foundation

  https://www.fusfoundation.org/posts/study-suggests-focused-ultrasound-treatment-of-aortic-valve-stenosis-safe-stroke-free/

  Beyond safety, aortic valve area, mean pressure gradient, and New York Heart Association (NYHA) functional classification all improved at one-month post-procedure. […] As a next step, the Valvosoft® Pivotal Study began in June 2022 and is currently enrolling 60 participants at 11 sites in France, Germany, and the Netherlands.

• #2 Aortic Stenosis | Lehigh Valley Health Network

  https://www.lvhn.org/conditions/aortic-stenosis

  Severe aortic valve stenosis is usually treated with replacing the valve, not repair. Medicine cannot make the valve open better. Aortic valve stenosis is a life-threatening disease once it becomes severe along with the development of symptoms. […] Replacement of the aortic valve can be done with open heart surgery or by placing a new valve through the leg artery without ever opening the chest (transcatheter aortic valve replacement or TAVR) in some patients. Patients treated with TAVR typically go home the next day. Either treatment option has an extremely high success rate in most patients. […] Your Lehigh Valley Heart and Vascular Institute team will develop an individualized care plan for you. […] After repairing or replacing the aortic valve, the team at Lehigh Valley Heart and Vascular Institute is here to help you recover. Cardiac rehabilitation is an important part of your recovery. You will benefit from an individualized program of supervised exercise and health education that focuses on lifestyle changes.

• #2 Causes, Symptoms and Treatments for Aortic Stenosis | Banner

  https://www.bannerhealth.com/services/heart/heart-disease/heart-valve-disease/aortic-stenosis

  Ultimately, patients suffering from severe, symptomatic aortic stenosis will need replacement of their aortic valve, which can either be accomplished via open heart surgery or via a minimally invasive procedure. […] Before 2011, patients would likely have open-heart surgery to replace the damaged valve and improve blood flow. Surgical aortic valve replacement (SAVR) involves open-heart surgery. […] After 2011, the U.S. Food and Drug Administration (FDA) approved a minimally invasive procedure called transcatheter aortic valve replacement, or TAVR. […] TAVR is becoming a more common practice, but it may not be right for all patients. […] SAVR and TAVR procedures greatly improve the longevity and quality of life for patients with aortic stenosis. […] Most patients who have undergone treatment for aortic stenosis will continue to receive lifelong follow-up to ensure that the valve continues to work as it should. But otherwise, the replaced valve will allow you to return to regular activities and exercise. Heart valve repair is a life-changing and lifesaving treatment.

• #2 Aortic Stenosis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23046-aortic-valve-stenosis

  Aortic valve stenosis (or aortic stenosis) happens when the aortic valve in your heart is narrowed or blocked. This interferes with the normal blood flow out of your heart. It makes your heart work harder, causing heart damage, major health problems and even death. Replacing the valve is the best treatment and gives you a good prognosis. […] But today, there are more options than ever to treat aortic stenosis. […] If you develop symptoms, your provider can offer you aortic stenosis treatment options, including: […] Medication: Providers treat milder cases of aortic valve stenosis with medications. These may include blood thinners, diuretics and other medicines to treat heart rhythm disorders, high blood pressure or heart failure. Medications help with symptoms but cant keep stenosis from getting worse.

• #2 Aortic Valve Disease | UNC Heart Valve Clinic

  https://www.med.unc.edu/medicine/cardiology/uncheartvalve/diseases-and-treatments/aortic-valve-disease/

  Patients benefit greatly when they can be evaluated by a multidisciplinary team, who then together decide on the best treatment option and provide the highest level of care. […] When traditional open heart surgery is needed for your aortic valve, you want a team of surgeons who offer the highest level of care and the most treatment options.

• #2 Your Aortic Stenosis Treatment Options

  https://global.newheartvalve.com/nz/explore-treatments/treatment-options/

  Taking the next step to find out about aortic stenosis treatment may feel overwhelming, but it is important to talk to your doctor about the options available to you. […] The only effective way to treat severe aortic stenosis is by replacing your heart valve. This can be done through transcatheter aortic valve implantation (TAVI) or open heart surgery. […] Your doctor will request several tests to determine the best treatment for you. Once your doctor has determined you need aortic valve replacement, they may refer you to a Heart Team at a specialised Heart Centre who can evaluate you for all your treatment options. […] There are two ways to replace your aortic valve: TAVI and open heart surgery. […] Depending on how far your aortic stenosis has progressed, your doctor may prescribe medication to help control symptoms. It is important to know that your heart valve will most likely need to be replaced in the future.

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