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Guidelines for the Management of Severe Aortic Stenosis
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Guidelines for the Management of Severe Aortic Stenosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Guidelines".

Deadline for manuscript submissions: closed (20 January 2025) | Viewed by 4461

Special Issue Editor

Dr. Srikanth Koneru

E-Mail Website
Guest Editor
Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
Interests: structural interventional imaging; cardiac CT and MRI imaging; valvular heart disease; interventional cardiology; HOCM; cardiomyopathy

Special Issue Information

Dear Colleagues,

Aortic stenosis (AS) is the most frequently encountered valvular heart disease. The therapeutic decision of aortic stenosis depends on patient’s symptoms, ventricular function, and severity of AS. Current therapeutic options include surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for symptomatic patients with severe AS. Long latency from initial diagnosis to symptom onset has been reported; however, once symptomatic, the survival rates are poor for patients without treatment, and despite appropriate treatment, the outcomes vary and depend on patients’ clinical characteristics. In most asymptomatic patients, watchful waiting with regular clinical and imaging follow-up is recommended, given the surgical risk is greater.

Furthermore, diagnosing patients with bioprosthetic aortic valve dysfunction is challenging and difficult, requiring good Doppler signal and appropriate echocardiographic windows. Reduced left ventricular systolic function, stroke volume and patient prosthesis mismatch further complicate the assessment of bioprosthetic aortic valve dysfunction.

However, echocardiography remains the cornerstone for the evaluation of AS for the majority of patients. Advanced multimodality cardiovascular imaging is essential to further guide early decision making and to confirm different stages of disease. There are several other parameters including valve anatomy/morphology, valve hemodynamics, changes in vasculature and ventricles, exercise testing and serum BNP levels to help guide early interventions.

We believe the readers of the Journal of Clinical Medicine will be interested in this Special Issue. We attempt to address the benefits of various multimodality imaging in diagnosing and guiding towards appropriate treatment strategy. Moreover, we will try to review various current treatment options, including SAVR/TAVR, bioprosthetic valve durability and future directions.

Dr. Srikanth Koneru
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic stenosis
  • low flow low gradient AS
  • TAVR
  • SAVR
  • multimodality imaging
  • valve in valve TAVR
  • patient prosthesis mismatch

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Published Papers (2 papers)

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Research

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12 pages, 1820 KiB  
Article
Management, Flow, and Outcomes of Patients with Aortic Stenosis Followed by a Heart Valve Clinic: The Untold “Behind the Scene” from a High-Volume, Real-World Experience
by Federico Cammertoni, Natalia Pavone, Piergiorgio Bruno, Gabriele Di Giammarco, Francesco Burzotta, Enrico Romagnoli, Antonella Lombardo, Francesca Graziani, Marialisa Nesta, Maria Grandinetti, Serena D’Avino, Alberta Marcolini, Gessica Cutrone, Edoardo Maria D’Acierno, Rudy Panzera, Gabriele Mazzenga, Marco Montesano and Massimo Massetti
J. Clin. Med. 2025, 14(1), 267; https://doi.org/10.3390/jcm14010267 - 5 Jan 2025
Viewed by 919
Abstract
Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with [...] Read more.
Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made. Full article
(This article belongs to the Special Issue Guidelines for the Management of Severe Aortic Stenosis)
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Review

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15 pages, 834 KiB  
Review
Perioperative Management of Valvular Heart Disease in Patients Undergoing Non-Cardiac Surgery
by Yashar Jalali, Monika Jalali and Ján Števlík
J. Clin. Med. 2024, 13(11), 3240; https://doi.org/10.3390/jcm13113240 - 30 May 2024
Cited by 1 | Viewed by 3050
Abstract
Postoperative cardiovascular complications (either in a hospital or within 30 days after the operation) are among the most common problems with non-cardiac surgeries (NCSs). Pre-existing cardiac comorbidities add significant risk to the development of such complications. Valvular heart disease (VHD), a rather frequent [...] Read more.
Postoperative cardiovascular complications (either in a hospital or within 30 days after the operation) are among the most common problems with non-cardiac surgeries (NCSs). Pre-existing cardiac comorbidities add significant risk to the development of such complications. Valvular heart disease (VHD), a rather frequent cardiac comorbidity (especially in the elderly population), can pose serious life-threatening peri-/postoperative complications. Being familiar with the recommended perioperative management of patients with VHD or an implanted prosthetic heart valve who are scheduled for NCS is of great importance in daily clinical practice. Although recently published guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology and American Heart Association (ACC/AHA) for the management of VHD and perioperative management of patients undergoing NCS addresses the mentioned problem, a comprehensive review of the guidelines that provides an easy-to-use summary of the recommendations and their similarities and differences is missing in the published literature. In this review article, we summarize all of the relevant important information based on the latest data published in both guidelines needed for practical decision-making in the perioperative management of patients with VHD or after valvular repair (with prosthetic heart valve) who are scheduled for NCS. Full article
(This article belongs to the Special Issue Guidelines for the Management of Severe Aortic Stenosis)
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