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2001, Number S1

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Arch Cardiol Mex 2001; 71 (S1)

When must patients with aortic stenosis be operated?

Cossío AJE

Language: Spanish
References: 13
Page: 40-44
PDF size: 40.06 Kb.


ABSTRACT

Optimal time for choosing Aortic Valve Replacement in Aortic Stenosis patients is based on understanding the natural history of the disease and prognostic variables, such as age, symptom status and co-morbid factors. In patients with advanced congestive heart failure, the valvular area and transvalvular gradients, determined by echocardiography and cardiac catheterization studies, have limitations for preoperative evaluation; before surgery the reversibility of this myocardial depression must be identified. At present, there is widespread agreement that valve replacement is indicated for symptomatic severe aortic stenosis regardless of age; however, cardiac surgery remains controveresial in asymptomatic patients but with abnormal response to exercise, ventricular tachycardia, valve area lesser than 0.6 cm2, and marked or excessive left ventricular hypertrophy. The presence of moderate or severe valvular calcification, together with a rapid increase in aortic-jet velocity, identifies patients with a very poor prognosis and these patients should be considered for surgery. Finally, the decission to operate a patient must be considered on individual factors and whether quality of life is improved, and not just on operative mortality and morbidity.


REFERENCES

  1. OTTO CATHERINE M: Valvular heart disease. 1999. W.B. Saunders Co. 202-217.

  2. AZPITARLE J: Guías de práctica clínica de valvulopatías. Rev Esp Cardiol 2000; 53: 1209- 1278.

  3. OTTO CM, LIND BK, KITZMAN DW, GERSCH BJ, SISCOVICK DS: For the cardiovascular health study. Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341: 1422-147.

  4. OTTO CM, BURWASH IG, LEGGET ME, FUJIOKA M, HEALY N, KRAFT CD, ET AL: A prospective study of asymptomatic valvular aortic stenosis: clinical echocardiographic, and exercise predictors of outcome. Circulation 1997; 95: 2252-70.

  5. JULIUS BK, SPILLMANN M, VASSALLI G, VILLARI B, EBERLI FR, HESS OM: Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiological concepts. Circulation 1997; 95: 892-8.

  6. OTTO C: Timing of aortic valve surgery. Heart 2000; 84: 211-218.

  7. BONOW RO, CARABELLO B, DE LEÓN A, EDMUNDS LH, FEDDERLY BJ, FREED M: ACC/AHA Task Force. Guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 1998; 32: 1486-588.

  8. ROSENHEK R, BINDER T, PORENTA G, LANG I, CHIRST G, SCHEMPER M, ET AL: Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000; 343: 611-617.

  9. GUADALAJARA JF, GALVAN O, NOGUERA J, ALEXANDERSON E, CERVANTES J, HUERTA D: Mecanismo de remodelación en las sobrecargas. Arch Inst Cardiol Mex 1995; 65: 217-28.

  10. CONNOLLY HM, OH JK, ORSZULAK TA: Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 1997; 95: 2395-2400.

  11. LUND O: Preoperative risk evaluation and stratification of long term survival after replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation 1990; 82: 124-34.

  12. CARABELLO BA, GREEN LH, GROSSMAN W, COHN L, KOSTER K, COLLINS J: Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation 1980; 62: 42-8.

  13. ZIEDALSKI TM, LIEBOWITZ RS, COPELAND JG: The oldest patient to undergo aortic valve replacement. Cardiology 1999; 92: 282-3.




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