Tag Archives: aortic stenosis

New generation diabetes drugs – a cardiorenal done deal? The meeting was opened by Professor William Herrington (Honorary Consultant Nephrologist, Oxford Kidney Unit) who discussed the impact of the new generation diabetes drugs on kidney outcomes.1 A meta-analysis of over 90,000 patients showed that sodium glucose co-transporter-2 (SGLT2) inhibitors slowed chronic kidney disease (CKD) progression by 37%, and decreased the risk of acute kidney injury, cardiovascular (CV) death or heart failure hospitalisation by 23%, regardless, the presence of diabetes or type of SGLT2 inhibitor used. Implementing these drugs is simple and can be done by

Several factors contribute to this treatment delay, including low patient awareness of the symptoms of valve disease, poor detection rates within primary care, limited access to diagnostic echocardiography, delayed referral to Heart Valve Clinics or Heart Centres, and prolonged waiting lists for surgical or transcatheter intervention.4–7 The prevalence of AS increases with age and typical symptoms, including breathlessness and dizziness, may be misinterpreted by primary care physicians as general signs of ageing rather than red flags for severe AS.6,8 In Europe, many patients are unable to access regular stethoscope checks to identify seve

Epidemiology of AS Prevalence AS is the most common valvular heart disease, accounting for 43% of valvular pathologies.1 Most cases are caused by calcification of the aortic valve leading to valve degeneration (termed calcified aortic valve disease [CAVD]), but rheumatic disease and congenital defects may also be responsible.8,9 The number of CAVD cases worldwide has been estimated at 9.4–12.6 million,9,10 although this may be an underestimate since many cases are asymptomatic and remain undiagnosed.11 Prevalence is particularly high in regions with a high sociodemographic index, including Europe, North America and Australasia, possibly re

AS awareness and detection Low detection rates of valvular heart disease (VHD) and AS are widespread, as many patients are diagnosed only when symptoms occur.5,8 The OxVALVE study (https://academic.oup.com/eurheartj/article/37/47/3515/2844994) showed that 51% of the population aged 65 years and older have undiagnosed VHD, and 1.3% have undiagnosed AS.5 Among the general population, a lack of awareness exists of AS and its symptoms. In a European survey of over 12,000 people aged 60 years and over, only a fifth were aware of VHD, and less than 4% could provide an accurate description of AS.9 National campaigns are recommended to raise public

The evidence supporting early discharge after TAVI Patients discharged early from hospital generally have a reduced risk of the physical and functional consequences associated with immobilisation and longer hospital stay, including hospital-acquired infections, functional dependency and cognitive decline.13,14 Elderly and frail patients are at risk of hospital-associated complications and are most likely to benefit from a shorter hospital stay.7,14 In the context of TAVI, the feasibility and safety of early discharge are well established.6–10,15 As early as 2015, early discharge was shown to be feasible and safe in approximately 80% of pat

Dr Anthony P C Bacon Introduction It may be invidious to write about oneself and one’s own disorders, but perhaps exception can be made when there is a gap of 60 years between writing about a condition and reporting one’s own case of it at the age of 94. In my case (APCB), the prospect of a general anaesthetic accompanied recurrent cholecystitis and dyspnoea, so I dusted off my stethoscope and on listening to my heart, I was somewhat taken aback to find that I had developed aortic stenosis. Early career Having qualified in 1947, and following 18 months in the Royal Army Medical Corps (RAMC) in Germany in 1948–9, I began work again in th

ACC.19 was held in New Orleans, US PARTNER 3 and Evolut Low Risk add to evidence base for TAVR Prior literature suggests that transcatheter aortic-valve replacement (TAVR) is non-inferior or even superior to standard surgical aortic-valve replacement (SAVR) among high and intermediate surgical risk patients with aortic stenosis (AS). Two pivotal studies have now addressed the efficacy and safety of TAVR in AS patients at low mortality risk from surgery. PARTNER 3 (ClinicalTrials.gov: NCT02675114) was an open-label trial that randomised 1,000 subjects with severe AS at low mortality risk from surgery into either TAVR with a third-generation ba

Professor John B Chambers Introduction Aortic stenosis (AS) is the most common type of primary heart valve disease in industrialised countries. Although echocardiography is key for its assessment, the need for surgery is most frequently dictated by symptoms.1 However, the history can be surprisingly elusive, and physicians without specialist competencies in valve disease may miss their onset.2 This is important because the risk of death is approximately 1% per annum without symptoms but 4% in the first three months after the onset of symptoms,3 usually before the patient has time to contact their physician (figure 1). It then rises up to 14%

Introduction Figure 1. View at time of implantation demonstrating a newly deployed JenaValveTM in a patient with a Medtronic-Hall disc valve in the mitral position Transcatheter aortic valve implantation (TAVI) has become standard of care for patients with severe aortic stenosis at prohibitive operative risk for surgical aortic valve replacement (SAVR).1 The first randomised-controlled trial of TAVI stipulated the presence of a mitral valve prosthesis as an exclusion criterion for enrolment in the trial.2 The main reason was concern that dysfunction of the mitral valve prosthesis might arise during TAVI valve deployment.3 Further concerns wer

Detailed preoperative work-up and careful patient selection with input from multi-disciplinary ‘heart teams’ (cardiac surgeons, interventional cardiologists, anaesthetists, nursing staff) are integral to good practice and to minimising the risk of what remains a complex and often challenging procedure. Serious complications (e.g. severe aortic regurgitation, major bleeding, device embolisation, coronary occlusion, and aortic dissection) are uncommon (<5%), but may precipitate sudden haemodynamic collapse necessitating cardiopulmonary bypass (CPB) or other mechanical support. Current guidelines, therefore, mandate ‘full haemodynamic c