Contemporary review of severe aortic stenosis
| Autor: | Srikkumar Ashokkumar, H. Adams, Andrew Newcomb, Robert Whitbourn, Andrew I. MacIsaac, Sonny Palmer |
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| Rok vydání: | 2019 |
| Předmět: |
Aortic valve
medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Decision Making 030204 cardiovascular system & hematology Global Health Risk Assessment Transcatheter Aortic Valve Replacement 03 medical and health sciences Postoperative Complications 0302 clinical medicine Aortic valve replacement Valve replacement Risk Factors Internal Medicine Humans Medicine 030212 general & internal medicine Intensive care medicine Patient Care Team business.industry Ross procedure valvular heart disease Australia Aortic Valve Stenosis medicine.disease Cardiac surgery medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Aortic valve stenosis business |
| Zdroj: | Internal Medicine Journal. 49:297-305 |
| ISSN: | 1445-5994 1444-0903 |
| DOI: | 10.1111/imj.14071 |
| Popis: | Severe aortic stenosis (AS) is the most common form of valvular heart disease in the developed world, with a rising prevalence due to an ageing Australian population. Transcatheter aortic valve implantation (TAVI) offers a less invasive option for the treatment of severe AS, with evidence supporting TAVI compared with medical therapy in inoperable patients and superior with surgical aortic valve replacement (SAVR) in high-risk patients. Equal outcomes have been observed in all-comer intermediate-risk populations. The Heart Team utilises a shared decision-making approach between physicians and surgeons in risk-stratifying patients and reduces the intrinsic bias that may occur if decisions are made in isolation. Geriatric assessment is useful for identifying preoperative frailty, a major risk factor for death post-aortic valve intervention. In severe AS, a decision can be made collaboratively to pursue TAVI, SAVR, a Ross Procedure or conservative management. The learning curve associated with TAVI has improved markedly, with overall complication rates decreasing around the world. Contemporary changes in practice, such as conscious sedation without general anaesthesia, expedited recovery and early discharge, will likely improve cost-effectiveness. In 2018, TAVI is a well-established procedure in Australia that has revolutionised the management of severe AS. In the future, with an expanding elderly population, the number of patients to benefit from transcatheter therapies for severe AS is hypothesised to increase 4-10-fold. Heart Team assessment is crucial in patients with severe AS to direct appropriate management. |
| Databáze: | OpenAIRE |
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