Презентация на тему Aortic Stenosis

common abnormality
Rheumatic heart disease and degeneration with calcification are

Normal Bicuspid Ao V “Normal” geriatric Rheumatic calcific valve

& 5th decades) think congenital or rheumatic
Bicuspid
2% population

Rarely
Unicuspid valve
Sub-aortic stenosis
Discrete
Diffuse (Tunnel)
Old patient think degenerative (6,7,8th decades)

reserve
Increased demand-high afterload
Syncope/Dizziness (exertional pre-syncope)
Fixed cardiac output
Vasodepressor response
Dyspnea on

of thrill DOES NOT predict severity
“Diamond” shaped, harsh, systolic

S2

stenosis 1.5-2.5 cm2
Moderate stenosis 1.0-1.5 cm2
Severe stenosis < 1.0

function
LA size
Concomitant regional wall motion abnormalities
Coarctation associated with bicuspid

, But…
AV gradient is

stenosis
Operative mortality (elderly) ~ 4%/Morbidity ~ 3-11%
Event rate in

expectancy to less than 2 years
Angina and syncope reduce

factors for operative mortality
Functional class
Lack of sinus rhythm
HTN
Pre-existing LV

Aortic regurgitation
Concomitant surgical procedures:CABG/MV surgery
Previous bypass
Emergency surgery
CAD
Female gender

AS (stage D1) with :
Decreased systolic opening of a

Access
TF TAVR
n = 179
Primary Endpoint: All-Cause Mortality Over Length

1:1 Randomization

VS

Symptomatic Severe Aortic Stenosis

Primary endpoint evaluated when all patients reached one year follow-up.
After primary endpoint analysis reached, patients were allowed to cross-over to TAVR.

Severe Symptomatic AS with AVA< 0.8 cm2 (EOA index < 0.5 cm2/m2), and mean gradient > 40 mmHg or jet velocity > 4.0 m/s

Inoperable defined as risk of death or serious irreversible morbidity of AVR as assessed by cardiologist and two surgeons exceeding 50%.

warfarin therapy
BIO-PROSTHETIC
Not durable
Smaller orifice/functional stenosis
Low thromboembolic potential
Consider in