Clinical Profile and Natural History of 453 Nonsurgically Managed Patients With Severe Aortic Stenosis

Varadarajan, Padmini; Kapoor, Nikhil; Bansal, Ramesh; Pai, Ramdas G.

doi:10.1016/j.athoracsur.2006.07.048

Cited by 422 publications

(246 citation statements)

References 7 publications

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“…In a study of 453 patients with nonsurgically managed severe AS, Varadarajan et al showed that among the patients not undergoing AVR, Bbl was not associated with a survival benefit 4. Although the present study was comprised of patients with asymptomatic AS, we found no interaction of Bbl treatment with either AS severity or time‐varying AVR per se and risk of all‐cause mortality.…”

Section: Discussioncontrasting

confidence: 56%

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Antihypertensive Treatment With β‐Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events

Bang

Greve

Rossebø

et al. 2017

JAHA

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BackgroundPatients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a β‐blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is associated with increased risk of cardiovascular events in patients with asymptomatic mild to moderate AS.Methods and ResultsWe did a post hoc analysis of 1873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity‐matched Cox regression and competing risk analyses were used to assess risk ratios for all‐cause mortality, sudden cardiac death, and cardiovascular death. A total of 932 (50%) patients received Bbl at baseline. During a median follow‐up of 4.3±0.9 years, 545 underwent aortic valve replacement, and 205 died; of those, 101 were cardiovascular deaths, including 40 sudden cardiovascular deaths. In adjusted analyses, Bbl use was associated with lower risk of all‐cause mortality (hazard ratio 0.5, 95% confidence interval 0.3‐0.7, P<0.001), cardiovascular death (hazard ratio 0.4, 95% confidence interval 0.2‐0.7, P<0.001), and sudden cardiac death (hazard ratio 0.2, 95% confidence interval 0.1‐0.6, P=0.004). This was confirmed in competing risk analyses (all P<0.004). No interaction was detected with AS severity (all P>0.1).ConclusionsIn post hoc analyses Bbl therapy did not increase the risk of all‐cause mortality, sudden cardiac death, or cardiovascular death in patients with asymptomatic mild to moderate AS. A prospective study may be warranted to determine if Bbl therapy is in fact beneficial.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

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Section: Discussioncontrasting

confidence: 56%

“…β‐Blockers (Bbls) are interesting in this regard, as they might reduce oxygen consumption and lower blood pressure to improve survival in AS patients 4. However, Bbls may also pose a danger of reduced inotropy in AS, and evidence for the safety and efficacy of Bbl use in AS is scarce.…”

Section: Introductionmentioning

confidence: 99%

Antihypertensive Treatment With β‐Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events

Bang

Greve

Rossebø

et al. 2017

JAHA

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“…1 Nevertheless, many patients do not undergo surgical aortic-valve replacement owing to real or perceived increased risks associated with surgery. [2][3][4][5] Transcatheter aorticvalve replacement (TAVR) has emerged as an alternative therapy in high-risk patients with aortic stenosis. [6][7][8][9][10] Observational registries from various countries have reported 1-month and 1-year outcomes after TAVR, [11][12][13][14] but there are limited long-term follow-up data.…”

Section: Discussionmentioning

confidence: 99%

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Kodali¹,

Williams²,

Smith³

et al. 2013

Survey of Anesthesiology

267

340

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“…Although meeting the well-defined criteria for the indication of the procedure, approximately 30-60% of patients may have a surgical indication denied because they are considered to be at high risk [2,16].…”

Section: Discussionmentioning

confidence: 99%

Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

Gaia¹,

Palma²,

Ferreira³

et al. 2010

Rev Bras Cir Cardiovasc

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Objective: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant.Methods: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU.Results: Implant was feasible in 13 cases. There were no intra-operative deaths. Rev Bras Cir Cardiovasc 2010; 25(3): 293-302 treatment. The survival rate with the technique was not satisfactory with a mortality rate of 65% at 1 year. Only 40% of patients at 1 year were free of reintervention, aortic valve replacement surgery, heart block, or death [6]. 294 GAIA, DF ET AL -Transapical aortic valve implantation: results of a Brazilian prosthesis

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Clinical Profile and Natural History of 453 Nonsurgically Managed Patients With Severe Aortic Stenosis

Cited by 422 publications

References 7 publications

Antihypertensive Treatment With β‐Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events

Antihypertensive Treatment With β‐Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

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