Added value of heart valve clinics in the management of asymptomatic aortic stenosis

Iung, Bernard; Banović, Marko

doi:10.1136/heartjnl-2022-322101

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…As decision-making is becoming more complex, clinical practice is embracing the growing evidence that dedicated heart valve clinics bring additional value to diagnostics, treatment and risk stratification of both asymptomatic patients with severe AS and patients with moderate AS. 45 , 46 Given the growing notion of poor outcomes in moderate AS and impaired myocardial function, the decision to intervene in moderate AS is increasingly debated. Initial retrospective studies have demonstrated that patients with moderate AS, especially those who were symptomatic and/or with impaired LVEF, have benefited from AVR.…”

Section: The Clinical Significance Of Moderate Aortic Stenosismentioning

confidence: 99%

Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications

et al. 2023

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Section: The Clinical Significance Of Moderate Aortic Stenosismentioning

confidence: 99%

Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications

et al. 2023

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“…The result is that concomitant coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) is one of the most commonly performed heart surgeries globally [ 2 ]. Combined valve and CABG surgery can decrease the rates of perioperative myocardial infarction (MI), as well as early and late mortality, when compared to patients with critical coronary artery disease (CAD) who do not receive revascularization at the time of valve surgery [ 3 , 4 ]. Many studies have addressed concomitant surgery and compared it to isolated CABG or AVR [ 5 , 6 ], with some showing increased perioperative risk of mortality and morbidity [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Trends and outcomes of concomitant aortic valve replacement and coronary artery bypass grafting in the UK and a survey of practices

Fudulu

Layton

Nguyen

et al. 2023

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Concomitant revascularization of coronary artery disease at the same time as treatment for aortic valvopathy favourably impacts survival. However, combined surgery maybe associated with increased adverse outcomes compared to aortic valve replacement or coronary artery bypass grafting in isolation. METHODS We retrospectively analyzed all patients who underwent aortic valve replacement with bypass grafting between February 1996 and March 2019 using data from the National Adult Cardiac Surgery Audit. We used a generalized mixed-effects model to assess the effect of the number and type of bypass grafts associated with surgical aortic valve replacement on in-hospital mortality, postoperative stroke, and the need for renal dialysis. Furthermore, we conducted an international cross-sectional survey of cardiac surgeons to explore their views about concomitant aortic valve replacement with coronary bypass grafting interventions. RESULTS Fifty-one thousand two hundred and seventy-two patients were included in the study. Patients receiving two or more bypass grafts demonstrated more significant pre-operative comorbidity and disease severity. Patients undergoing two and more than two grafts in addition to aortic valve replacement had increased mortality as compared to patients undergoing aortic valve replacement and only one graft (OR 1.17 95% CI [1.05–1.30], p = 0.005 and OR 1.15 95% [1.02–1.30], p = 0.024 respectively). A single arterial conduit was associated with a reduction in mortality (OR 0.75 95% CI [0.68–0.82], p < 0.001), and post-operative dialysis (OR 0.87 95% CI [0.78–0.96], p = 0.006), but this association was lost with more than one arterial conduit. One hundred and three surgeons responded to our survey, with only a small majority believing that the number of bypass grafts can influence short or long-term post-operative outcomes in these patients, and an almost equal split in responders supporting the use of staged or hybrid interventions for patients with concomitant pathology. CONCLUSIONS The number of grafts performed during combined AVR and CABG is associated with increased morbidity and mortality. The use of an arterial graft was also associated with reduced mortality. Future studies are needed to assess the effect of incomplete revascularisation and measure long-term outcomes. Based on our data, current published evidence, and the collective expert opinion we gathered, we endorse future work to investigate the short and long-term efficacy and safety of hybrid intervention for patients with concomitant advanced coronary and aortic valve disease.

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“…The answers to the remarks of the author are perfectly summarised in the excellent editorial ‘Added value of heart valve clinics in the management of asymptomatic aortic stenosis’ 2. The editorial underlines the gap between guidelines-recommended intervention in valvular heart disease (VHD) and the real-world situation.…”

mentioning

confidence: 99%

Response to: Correspondence on “Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics” by José Alberto San Román

Camp

2023

Heart

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Added value of heart valve clinics in the management of asymptomatic aortic stenosis

Cited by 5 publications

References 8 publications

Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications

Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications

Trends and outcomes of concomitant aortic valve replacement and coronary artery bypass grafting in the UK and a survey of practices

Response to: Correspondence on “Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics” by José Alberto San Román

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