Dual Renin-Angiotensin System Blockade for Patients With Prosthesis-Patient Mismatch

Benedetto, Umberto; Melina, Giovanni; Refice, Simone; Bartolomeo, Roberta Di; Roscitano, Antonino; Angeloni, Emiliano; Sinatra, Riccardo

doi:10.1016/j.athoracsur.2010.08.023

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…Prospective randomized investigation of 114 patients demonstrated that candesartan achieved greater LV mass regression, 30 verses 12 g/m 2 , at 12 months [89]. Combining ACE-i and ARB II blockade enhanced the LVH regression after SAVR in the presence of PPM [90]. Geol et al [91] reported a large cohort study of 1752 SAVR cases for AS together with propensity matched analysis of 594 pairs, showing the beneficial effects of RASI in up to 10-year survival (Fig.…”

Section: Effects Of Pacemaker and Bundle Branch Block On LV Remodelling And Outcomementioning

confidence: 98%

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Jin

Petrou

et al. 2021

Front. Med.

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Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

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Section: Effects Of Pacemaker and Bundle Branch Block On LV Remodelling And Outcomementioning

confidence: 98%

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Jin

Petrou

et al. 2021

Front. Med.

View full text Add to dashboard Cite

show abstract

Left Ventricular Function and Aortic Valve Replacement

Jin

Pepper

2019

Surgical Management of Aortic Pathology

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Pre- and Post-Operative Diastolic Dysfunction in Patients With Valvular Heart Disease

Zaid

Barker

Little

et al. 2013

Journal of the American College of Cardiology

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Patients with valvular heart disease often have left ventricular diastolic dysfunction. This review summarizes the underlying mechanisms for diastolic dysfunction in patients with mitral and aortic valve disease. In addition to load, intrinsic myocardial abnormalities occur related to changes in sarcomeric proteins, abnormal calcium handling, and fibrosis. Echocardiography is the initial modality for the diagnosis of left ventricular diastolic function. Although there are challenges to conventional Doppler parameters of diastolic function, it is often possible to arrive at a clinically useful assessment of left ventricular filling pressures using a comprehensive approach. When needed, cardiac magnetic resonance and cardiac catheterization can be obtained. Medical therapy can be of value for the treatment of diastolic dysfunction, but there is a paucity of data evaluating its clinical utility. More importantly, diastolic dysfunction usually improves with timely surgical intervention, although surgery does not always lead to normalization of function.

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Dual Renin-Angiotensin System Blockade for Patients With Prosthesis-Patient Mismatch

Cited by 5 publications

References 15 publications

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Left Ventricular Function and Aortic Valve Replacement

Pre- and Post-Operative Diastolic Dysfunction in Patients With Valvular Heart Disease

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