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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Heart Failure and Moderate Aortic Stenosis: is Early TAVI the Better Strategy?
Michele Legati1, Luca Branca1, Angelica Cersosimo1
1Institute of Cardiology, ASST Spedali Civili and University of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Piazzale Spedali Civili 1, 25100 Brescia, Italy.
Summary
Early aortic valve replacement for moderate aortic stenosis (AS) in heart failure with reduced ejection fraction (HFrEF) patients is not yet evidence-based. While potentially beneficial, current trials show mixed results, necessitating further research.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Heart Failure
Background:
- Aortic stenosis (AS) is the most common valvular heart disease in Western countries.
- Current guidelines recommend intervention only for severe AS.
- Emerging evidence suggests moderate AS may also lead to adverse outcomes, especially in heart failure with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To evaluate the potential benefits of early aortic valve replacement (AVR) in patients with moderate AS and HFrEF.
- To assess if early AVR can improve survival and reduce heart failure hospitalizations.
- To determine if treating moderate AS can improve hemodynamic status and facilitate guideline-directed medical therapy (GDMT) in HFrEF patients.
Main Methods:
- Review of current clinical guidelines and evidence.
- Analysis of retrospective observational studies.
- Consideration of findings from the TAVR UNLOAD trial and ongoing randomized trials.
Main Results:
- Retrospective studies suggest potential benefits of early AVR in moderate AS with HFrEF.
- The TAVR UNLOAD trial did not show a prognostic benefit of transcatheter aortic valve implantation (TAVI) in moderate AS with HFrEF/HFmrEF.
- Two ongoing randomized trials are expected to provide more definitive evidence.
Conclusions:
- The pathophysiological rationale for early AVR in moderate AS with HFrEF is sound.
- Current evidence is predominantly from observational studies, with limited randomized trial data.
- An early AVR strategy for moderate AS cannot currently be considered evidence-based.
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