PLoS One, 14 (2019), Article e0222979, 10.1371/journal.pone.0222979. Investigators. Seoul, Korea. However, there is a knowledge gap regarding the magnitude of clinical benefit provided by TAVI in comparison with conservative management in patients with severe aortic stenosis (AS) in real clinical practice, which would be important . Aortic stenosis is a very common disease. 1 2 surgical aortic valve replacement (savr) had been the only effective treatment for severe as for many years. Therefore, the accurate diagnosis of the disease, determination of its severity and precise evaluation of patients' clinical status is essential. Early surgical AVR (vs. conservative management) significantly reduced the rates of operative or cardiovascular death, and death from any cause in When compared to early AVR, conservative management has statistically significant higher risk of all causes mortality (RR: 0.36, 95%CI [0.31 to 0.42], p<0.00001, figure 1), cardiovascular mortality (RR: 0.32, 95%CI [0.24 to 0.41], p<0.00001, figure 2), and non-cardiovascular mortality (RR: 0.42, 95%CI [0.24 to 0.56], p=0.0005). At a median of 6 years of . The AVATAR trial demonstrated benefits of early surgical aortic valve replacement compared with conservative management in patients with asymptomatic severe aortic stenosis with a normal left ventricular function. When symptomatic, AS is known to have significant morbidity and mortality. 3 however, transcatheter aortic valve Asymptomatic patients with very severe aortic stenosis were randomly assigned to either early valve-replacement surgery or conservative care. aortic stenosis is the valvular heart lesion with the highest clinical impact and mortality worldwide, accounting for half of valve- related deaths.1 2for patients with sympto- matic severe aortic stenosis, european and american guidelines indicate that aortic valve replacement is advised as a class ib and class ia recommendation, respectively.3 Clinical management was not significantly different with different degrees of comorbidity. aortic stenosis (as) is a slowly progressive disease but is associated with dismal outcomes within a few years after symptom emergence if not treated with aortic valve replacement (avr). 1 ). The main reasons for conservative management were "comorbidities" in 128 (43.8%) patients; "dementia" in 18 (6.2%); "advanced age" in 34 (11.6%); "patient's refusal" in 62 (21.2%) and "others" in 50 (17.1%) cases ( Fig. Home Journal of the American Heart Association Vol. Aortic stenosis is the most common valvular disease for which surgery is indicated in developed countries, and the . Background Transcatheter aortic valve implantation (TAVI) is criticized by some as an expensive treatment in super-elder patients with limited life expectancy. However, there is a knowledge gap regarding the magnitude of clinical benefit provided by TAVI in comparison with conservative management in patients with severe aortic stenosis (AS) in real clinical practice, which would be important in the decision making for TAVI. Results: A total of 8107 ESRD-HD patients with aortic stenosis were included, 4130 (50%) underwent TAVR, 2565 (31.6%) underwent SAVR, and 1412 (17.4%) were managed conservatively. Perspective Chapter: Moderate Aortic Stenosis and Heart Failure with Reduced Ejection Fraction; Early Replacement or Conservative Treatment? 1 surgical aortic valve replacement (savr) and transcatheter aortic valve replacement (tavr) are the recommended treatment strategies due to their association with significant improvement in survival and Aortic valve stenosis (AS) is the most common valvular heart disease in developed countries. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Aortic valve replacement also increases stroke risk even with warfarin. We conducted an updated meta-analysis to compare the outcomes of surgical AVR (SAVR) versus conservative treatment in patients with asymptomatic severe AS. Till now, the specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial. Predictors of a conservative management were treatment out of TAVI centres, lower mean aortic gradient and better functional class. using indirect standardization with death rates from age-sex matched esrd-hd population in the u.s., as in patients with esrd-hd was associated with 83% increase in mortality when managed conservatively (smr 183), whereas the increase in mortality in patients with as who underwent tavr or savr was substantially smaller (24% (smr 124) and 27% (smr on behalf of the . Introduction. aortic stenosis (as) is the most frequent type of valvular heart disease in the elderly, which affects more than 10% of the population aged more than 65 years. 24 Comparison of Early Surgical or Transcatheter Aortic Valve Replacement Versus Conservative Management in LowFlow, LowGradient Aortic Stenosis Using Inverse Probability of Treatment Weighting: Results From the TOPAS Prospective Observational Cohort Study Background: There has been no previous report evaluating the long impact of atrial fibrillation (AF) on the clinical outcomes stratified by the initial management [conservative or aortic valve replacement (AVR)] strategies of severe aortic stenosis (AS). VISUAL ABSTRACT Early Surgery or Conservative Care for Aortic Stenosis. . Background: Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Transcatheter Aortic Valve Implantation) registry and CURRENT AS (Contemporary out-comes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, to make a historical comparison of the clinical outcomes between TAVI and conservative management in patients with severe AS. Secondary outcomes included trend of heart failure hospitalizations. TAVR patients had more comorbidities and higher frailty compared with the other 2 groups. The main objective was to determine the optimal strategy for managing asymptomatic severe aortic stenosis between early intervention versus conservative management. We performed a systematic electronic search of the PubMed and Cochrane databases from the inception of the database to May 31, 2020. Abstract. Among patients with asymptomatic severe aortic stenosis, early surgery was beneficial. Median follow-up was 28 months in early surgery group and 35 months in the conservative treatment group. AHA 2019 Late Breaking Trial . These results show that surgery is indicated when aortic stenosis is significant, albeit asymptomatic [1]. An OR/HR <1 favors early AVR and an OR/HR > 1 supports conservative management. Continuous advances in both surgical and percutaneous techniques have . Aortic Stenosis. Reasons for Choosing Conservative Management in Symptomatic Patients With Severe Aortic Stenosis - Observations From the CURRENT AS Registry Patient rejection was the reason for non-referral to AVR in nearly one-quarter of the symptomatic patients with severe AS who were managed conservatively. We performed a focused review and meta-analysis of all the randomised trials in the literature comparing aortic valve intervention with conservative management in patients with asymptomatic severe aortic stenosis. Transcatheter aortic valve implantation versus conservative management for severe aortic stenosis in real clinical practice. Methods: The AVATAR trial (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) is an investigator-initiated international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area 1 cm 2 with aortic jet velocity >4 m . Asterios Karakanas, Theodoros Michailidis, Christos Gogos, Dimitrios Patoulias, Georgia Nazou and Nikolaos Schizas . D.-H. Kang and Others. 1. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. The primary endpoint occurred significantly more in the conservative management arm (34.7%) compared to the SAVR arm (15.2%), with a hazard ratio of 0.46 [95% CI, 0.23-0.90]; P =0.02. Hypothes. While the prevalence of AS is expected to rise with the aging population, there is no pharmacological treatment option to prevent its progression at this time [ 1, 2 ]. RECOVERY. in the united states (us), aortic stenosis (as) is the most common valvular heart disease, representing a significant public health burden. Aortic Stenosis Recent Advances, New Perspectives and Applications Edited . Statistical . Pitfalls in the evaluation of aortic valve stenosis. The primary endpoints of this meta-analysis included all-cause mortality, cardiovascular death and hospitalisation for heart failure. Methods: We analyzed 3815 patients with severe AS enrolled in the CURRENT AS registry. Aortic stenosis (AS) is the most common valvular heart disease, affecting approximately 5% of adults above the age of 65 years , . Background Aortic stenosis (AS) is the most common valvular disease in developed countries. A trend toward higher mortality in patients undergoing conservative management was observed (58% vs. 40.7%, p=0.097). We combined two independent registries, namely CURRENT AS and K-TAVI registries. Medical treatment (such as diuretic therapy) in aortic stenosis may provide temporary symptom relief but is generally not effective long term. The . Early surgery compared with conservative therapy was associated with a significantly lower incidence of composite adverse events over a median follow-up of 32 months. In recent years, transcatheter aortic valve implantation (TAVI) has been performed widely; however, older patients may be ineligible for TAVI or surgical treatment because of medical ineligibility. 9, No. Conclusions: Patients with severe symptomatic aortic stenosis managed conservatively have different baseline characteristics and clinical course according to the reason for performing conservative. Written By. 1, 2, 3 aortic valve replacement (avr) is strongly recommended for symptomatic patients with severe as because the 2-year mortality approaches 60% without surgical intervention. Introduction: The management of asymptomatic severe aortic stenosis (AS) is controversial and guidelines for the management of the same is not updated based on recently available evidence. In truly asymptomatic patients with severe aortic. Background Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. 4,5 in Duk-Hyun Kang MD PhD. Download : Download high-res image (206KB) Download : Download full-size image Fig. Asan Medical Center. Aortic valve replacement (AVR) therapy is obvious choice in symptomatic severe aortic stenosis (AS) patients, because it improves symptoms, LV function and survival. While aortic valve replacement (AVR) is indicated for symptomatic severe aortic stenosis (AS), the appropriate management of asymptomatic severe AS remains unclear. The total population prevalence of moder The incidence of aortic stenosis (AS) increases with age and is a serious problem in an aging society.