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Aortic Stenosis: Diagnosis, Treatment and Management
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Aortic Stenosis: Diagnosis, Treatment and Management

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Pediatric Cardiology and Congenital Heart Disease".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 14072

Special Issue Editors

Prof. Dr. Alessandro Santo Bortone

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Guest Editor
Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy
Interests: transcatheter aortic valve implantation; early discharge; acute kidney injury; horizontal aorta; aortic dissection; transcatheter endovascular aortic repair
Dr. Fortunato Iacovelli

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Guest Editor
Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro”, 70124 Bari, Italy
Interests: transcatheter aortic valve implantation; acute kidney injury; conduction disturbances; vascular complications; horizontal aorta; coronary artery ectasia

Special Issue Information

Dear Colleagues,

Aortic stenosis is the most common primary valve disease, the incidence of which increases with age, affecting up to 10% of people older than 80 years old. According to new guidelines, valve replacement seems to be the most effective treatment option: To date, the transcatheter approach has spread worldwide and its past limitations have now been overcome.

Notably, the first metanalysis, including data from the PARTNER 3 and Evolut Low Risk trials, found no statistically significant differences between transcatheter aortic valve implantation and surgical aortic valve replacement in mortality and stroke or transient ischemic attack in the short- or mid‐term in low‐risk patients: Such discovery could lead to the use of this technique also in low surgical risk patients, even if this is not part of the daily clinical practice yet.

Despite technological progresses and increased operator’s expertise have contributed to decrease their rate, the transcatheter approach could provoke either intraprocedural or postprocedural complications. Such complications, as well as particular anatomical settings (horizontal aorta, small annulus, valve‐in‐valve, bicuspid aortic valve, low coronary ostia, etc.) will surely be the most interesting research topics in this field.

Prof. Dr. Alessandro Santo Bortone
Dr. Fortunato Iacovelli
Guest Editors

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Keywords

  • transcatheter aortic valve implantation
  • surgical aortic valve replacement
  • sutureless prostheses
  • conduction disturbances
  • acute kidney injury
  • horizontal aorta

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Published Papers (6 papers)

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Research

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11 pages, 1866 KiB  
Article
Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff
by Stefano Benenati, Francesco Gallo, Won-keun Kim, Arif A. Khokhar, Tobias Zeus, Stefan Toggweiler, Roberto Galea, Federico De Marco, Antonio Mangieri, Damiano Regazzoli, Bernhard Reimers, Luis Nombela-Franco, Marco Barbanti, Ander Regueiro, Tommaso Piva, Josep Rodes-Cabau, Italo Porto, Antonio Colombo, Francesco Giannini and Alessandro Sticchi
J. Cardiovasc. Dev. Dis. 2024, 11(1), 33; https://doi.org/10.3390/jcdd11010033 - 22 Jan 2024
Viewed by 2227
Abstract
Background: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged [...] Read more.
Background: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. Results: A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99–1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63–1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). Conclusions: TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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13 pages, 932 KiB  
Article
Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong?
by Fortunato Iacovelli, Francesco Loizzi, Alessandro Cafaro, Osvaldo Burattini, Luigi Salemme, Angelo Cioppa, Francesco Rizzo, Chiara Palmitessa, Maurizio D’Alessandro, Daniele De Feo, Armando Pucciarelli, Emanuela De Cillis, Vincenzo Pestrichella, Gaetano Contegiacomo, Tullio Tesorio and Alessandro Santo Bortone
J. Cardiovasc. Dev. Dis. 2023, 10(6), 244; https://doi.org/10.3390/jcdd10060244 - 31 May 2023
Cited by 2 | Viewed by 1619
Abstract
Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk [...] Read more.
Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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12 pages, 727 KiB  
Article
Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results
by Nora Berisha, Kathrin Klein, Verena Veulemans, Oliver Maier, Kerstin Piayda, Stephan Binnebößel, Shazia Afzal, Amin Polzin, Ralf Westenfeld, Patrick Horn, Christian Jung, Malte Kelm, Christine Quast and Tobias Zeus
J. Cardiovasc. Dev. Dis. 2022, 9(6), 189; https://doi.org/10.3390/jcdd9060189 - 10 Jun 2022
Cited by 1 | Viewed by 1832
Abstract
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and [...] Read more.
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; p < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; p = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; p = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; p = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; p = 0.001) and a longer procedural time (80.2 min (+/−29.4) vs. 66.9 min (+/−17.5); p < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/−5.9) vs. 9.5 days (+/−9.33); p = 0.041) and fewer TAVR patients were treated per month (39 (+/−4.55) vs. 46.11 (+/−7.57); p = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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Review

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19 pages, 3147 KiB  
Review
Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation
by Philipp Lauten, Lisa C. Costello-Boerrigter, Björn Goebel, David Gonzalez-Lopez, Matthias Schreiber, Thomas Kuntze, Mahmoud Al Jassem and Harald Lapp
J. Cardiovasc. Dev. Dis. 2023, 10(6), 230; https://doi.org/10.3390/jcdd10060230 - 24 May 2023
Cited by 2 | Viewed by 2986
Abstract
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges [...] Read more.
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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20 pages, 1545 KiB  
Review
Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach
by Andreas Mitsis, Xun Yuan, Christos Eftychiou, Panayiotis Avraamides and Christoph A. Nienaber
J. Cardiovasc. Dev. Dis. 2022, 9(11), 407; https://doi.org/10.3390/jcdd9110407 - 21 Nov 2022
Cited by 1 | Viewed by 2861
Abstract
Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device [...] Read more.
Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device is better than the other or that one device is suitable for all patients. The selection of the optimal TAVI valve for every patient represents a challenging process for clinicians, given a large number of currently available devices. Consequently, understanding the advantages and disadvantages of each valve and personalising the valve selection based on patient-specific clinical and anatomical characteristics is paramount. This review article aims to both analyse the available devices in the presence of specific clinical and anatomic features and offer guidance to select the most suitable valve for a given patient. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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Other

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8 pages, 1961 KiB  
Case Report
Intracoronary Pacing during “Chimney Technique” in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation?
by Alessandro Cafaro, Francesco Rizzo, Dionigi Fischetti, Luca Quarta, Marco Mussardo, Alessandro Mandurino-Mirizzi, Antonio Tondo, Marco Matteo Ciccone, Fortunato Iacovelli and Giuseppe Colonna
J. Cardiovasc. Dev. Dis. 2023, 10(8), 341; https://doi.org/10.3390/jcdd10080341 - 8 Aug 2023
Viewed by 1570
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and [...] Read more.
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the “chimney technique”, after unsuccessful RLE-TRVP. Full article
(This article belongs to the Special Issue Aortic Stenosis: Diagnosis, Treatment and Management)
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