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Transcatheter Aortic Valve Implantation in Heart Failure Patients with Non-Severe Aortic Valve Stenosis

Amr Elkammash

Abstract


Introduction: aortic stenosis (AS) increases the afterload on the left ventricle, leading to structural changes in the heart muscle and gradual progression to heart failure (HF). The clinical guidelines recommend aortic valve replacement (surgical or transcatheter) in patients with HF and severe AS. The evidence on the benefits of Transcatheter aortic valve implantation (TAVI) for patients with less-than-severe AS and HF is still controversial and inconclusive. Methods: the literature was systematically searched on three different scientific databases (PUBMED, Google Scholar, EMBASE) using different combinations of search words (heart failure, non-severe aortic stenosis, less-than-severe aortic stenosis, mild to moderate aortic stenosis, TAVI, TAVR). Results: in heart failure patients, observational studies showed a significant reduction in mortality using TAVI to manage non-severe aortic stenosis compared to medical treatment. However, evidence from randomized controlled trials is still lacking. Conclusion:HF increases the surgical risk of AS patients; therefore, TAVI represents a safer option. The preliminary results indicated the benefit of TAVI in managing AS in HF patients, even if the AS did not reach the severe stage.

 

Doi: 10.28991/SciMedJ-2022-04-04-05

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Keywords


TAVI; TAVR; Heart Failure; Aortic Stenosis; Surgical Aortic; Valve Replacement.

References


Delesalle, G., Bohbot, Y., Rusinaru, D., Delpierre, Q., Maréchaux, S., & Tribouilloy, C. (2019). Characteristics and Prognosis of Patients with Moderate Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Journal of the American Heart Association, 8(6), 8. doi:10.1161/JAHA.118.011036.

van Gils, L., Clavel, M. A., Vollema, E. M., Hahn, R. T., Spitzer, E., Delgado, V., Nazif, T., De Jaegere, P. P., Geleijnse, M. L., Ben-Yehuda, O., Bax, J. J., Leon, M. B., Pibarot, P., & Van Mieghem, N. M. (2017). Prognostic Implications of Moderate Aortic Stenosis in Patients with Left Ventricular Systolic Dysfunction. Journal of the American College of Cardiology, 69(19), 2383–2392. doi:10.1016/j.jacc.2017.03.023.

Ancona, R., & Comenale Pinto, S. (2020). Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world?. E-Journal of Cardiology Practice, 18, 10.

Dillane, D. (2021). Aortic stenosis. In Preoperative Assessment: A Case-Based Approach, Springer, Cham, Switzerland. doi:10.1007/978-3-030-58842-7_7.

Pedriali, G., Morciano, G., Patergnani, S., Cimaglia, P., Morelli, C., Mikus, E., Ferrari, R., Gasbarro, V., Giorgi, C., Wieckowski, M. R., & Pinton, P. (2020). Aortic Valve Stenosis and Mitochondrial Dysfunctions: Clinical and Molecular Perspectives. International Journal of Molecular Sciences, 21(14), 4899. doi:10.3390/ijms21144899.

Badiani, S., Bhattacharyya, S., Aziminia, N., Treibel, T. A., & Lloyd, G. (2021). Moderate aortic stenosis: What is it and when should we intervene? Interventional Cardiology: Reviews, Research, Resources, 16. doi:10.15420/ICR.2021.04.

Pankayatselvan, V., Raber, I., Playford, D., Stewart, S., Strange, G., & Strom, J. B. (2022). Moderate aortic stenosis: Culprit or bystander? Open Heart, 9(1), 1-6. doi:10.1136/openhrt-2021-001743.

Dweck, M. R., Joshi, S., Murigu, T., Gulati, A., Alpendurada, F., Jabbour, A., MacEira, A., Roussin, I., Northridge, D. B., Kilner, P. J., Cook, S. A., Boon, N. A., Pepper, J., Mohiaddin, R. H., Newby, D. E., Pennell, D. J., & Prasad, S. K. (2012). Left ventricular remodeling and hypertrophy in patients with aortic stenosis: Insights from cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance, 14(1), 1-9. doi:10.1186/1532-429X-14-50.

Awtry, E., & Davidoff, R. (2011). Low-flow / low-gradient aortic stenosis. Circulation (American Heart Association), 124(23), 124:e739–e741. doi:10.1161/CIRCULATIONAHA.111.075853.

Chambers, J. (2006). Low “gradient”, low flow aortic stenosis. Heart, 92(4), 554–558. doi:10.1136/hrt.2005.079038.

Clayton, B., Morgan-Hughes, G., & Roobottom, C. (2014). Transcatheter aortic valve insertion (TAVI): A review. British Journal of Radiology, 87(1033). doi:10.1259/bjr.20130595.

Masson, J. B., Kovac, J., Schuler, G., Ye, J., Cheung, A., Kapadia, S., Tuzcu, M. E., Kodali, S., Leon, M. B., & Webb, J. G. (2009). Transcatheter Aortic Valve Implantation. Review of the Nature, Management, and Avoidance of Procedural Complications. JACC: Cardiovascular Interventions, 2(9), 811–820. doi:10.1016/j.jcin.2009.07.005.

Arias, E. A., Bhan, A., Lim, Z. Y., & Mullen, M. (2019). TAVI for Pure Native Aortic Regurgitation: Are We There Yet? Interventional Cardiology Review, 14(1), 26–30. doi:10.15420/icr.2018.37.1.

Baumgartner, H., Falk, V., Bax, J. J., De Bonis, M., Hamm, C., Holm, P. J., Iung, B., Lancellotti, P., Lansac, E., Rodriguez Muñoz, D., Rosenhek, R., Sjögren, J., Tornos Mas, P., …, Roffi, M. (2017). 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 38(36), 2739–2791. doi:10.1093/eurheartj/ehx391.

Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews, 18(2), 18 1230. doi:10.1002/cl2.1230.

Ludwig, S., Schofer, N., Abdel-Wahab, M., Urena, M., Jean, G., Renker, M., Hamm, C. W., Thiele, H., Iung, B., Ooms, J. F., Wiessman, M., …, Clavel, M.-A. (2023). Transcatheter Aortic Valve Replacement in Patients with Reduced Ejection Fraction and Nonsevere Aortic Stenosis. Circulation: Cardiovascular Interventions, 16(5). doi:10.1161/circinterventions.122.012768.

Jean, G., Van Mieghem, N. M., Gegenava, T., van Gils, L., Bernard, J., Geleijnse, M. L., Vollema, E. M., El Azzouzi, I., Spitzer, E., Delgado, V., Bax, J. J., Pibarot, P., & Clavel, M. A. (2021). Moderate Aortic Stenosis in Patients With Heart Failure and Reduced Ejection Fraction. Journal of the American College of Cardiology, 77(22), 2796–2803. doi:10.1016/j.jacc.2021.04.014.

Annabi, M. S., Côté, N., Dahou, A., Bartko, P. E., Bergler-Klein, J., Burwash, I. G., Orwat, S., Baumgartner, H., Mascherbauer, J., Mundigler, G., …, Clavel, M. A., & Pibarot, P. (2020). Comparison of early surgical or transcatheter aortic valve replacement versus conservative management in low-flow, low-gradient aortic stenosis using inverse probability of treatment weighting: Results from the topas prospective observational cohort study. Journal of the American Heart Association, 9(24). doi:10.1161/JAHA.120.017870.

Spitzer, E., Van Mieghem, N. M., Pibarot, P., Hahn, R. T., Kodali, S., Maurer, M. S., Nazif, T. M., Rodés-Cabau, J., Paradis, J. M., Kappetein, A. P., Ben-Yehuda, O., van Es, G. A., Kallel, F., Anderson, W. N., Tijssen, J., & Leon, M. B. (2016). Rationale and design of the Transcatheter Aortic Valve Replacement to UNLOAD the Left ventricle in patients with Advanced heart failure (TAVR UNLOAD) trial. American Heart Journal, 182, 80–88. doi:10.1016/j.ahj.2016.08.009.

Otto, C. M., Nishimura, R. A., Bonow, R. O., Carabello, B. A., Erwin, J. P., Gentile, F., Jneid, H., Krieger, E. V., Mack, M., McLeod, C., O’Gara, P. T., Rigolin, V. H., Sundt, T. M., Thompson, A., & Toly, C. (2021). 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 77(4), 450–500. doi:10.1016/j.jacc.2020.11.035.


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DOI: 10.28991/SciMedJ-2022-04-04-05

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