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Indications, Safety, and Warnings
After developing symptomatic severe aortic stenosis, the average patient survival is two years without treatment. 12
Aortic stenosis is among the most common of all valvular heart diseases and continues to increase as our population ages.13
Symptomatic severe aortic stenosis (SSAS) can be fatal if left untreated.
DUE TO THE FOLLOWING FACTORS, SSAS ISN'T ALWAYS EASY TO DIAGNOSE:
Mortality difference for people with symptoms of aortic stenosis treated with aortic valve replacement versus those not undergoing this procedure is one of the most striking in medicine.17
Class 1B recommendation for intervention: Patients with symptomatic severe high-gradient aortic stenosis, low-flow, low-gradient aortic stenosis with reduced ejection fraction, AND evidence of flow reserve.
Class 1B and 1C recommendation for intervention: Expanded to asymptomatic severe aortic stenosis patients, considering a careful heart team evaluation of their treatment need.18
Current evidence reinforces the critical role of the Heart Team, which should integrate clinical, anatomical, and procedural characteristics beyond conventional scores, and informed patient’s treatment choice.18— 2021 ESC/EACTS Valvular Heart Disease Guidelines
According to the European Heart Health Survey only 6% of people over the age of 60 years can correctly describe aortic valve stenosis. In addition the respondents were less concerned about heart valve disease than with cancer.19
It's easier to help patients when you know what they're thinking. The insights gathered from a new national survey conducted by Heart-Valve-Surgery.com, with support from Medtronic, can help you better understand the heart valve patient experience.
The European Heart Health Survey was conducted 2019, including a total of 12'832 people aged ≥ 60 years in 11 European countries.
STS Adult Cardiac Database. 2010 Harvest, Isolated AVR.
Bach DS, Cimino N, Deeb GM. Unoperated patients with severe aortic stenosis. J Am Coll Cardiol. November 13, 2007;50(20):2018-2019.
Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. June 21, 2005;111(24):3290-3295.
Charlson E, Legedza AT, Hamel MB. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis. May 2006;15(3):312-321.
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. September 16, 2006;368(9540):1005-1011.
Lindroos M, Kupari M, Heikkilä J, Tilvis R. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol. April 1993;21(5):1220-1225.
Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA. November 20, 2013;310(19):2069-2077.
Medtronic data on file #1.
lung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. July 2003;24(13):1231-1243.
Durko AP, Osnabrugge RL, Van Mieghem NM, Milojevic M, Mylotte D, Nkomo VT, Pieter Kappetein A. Annual number of candidates for transcatheter aortic valve implantation per country: current estimates and future projections. Eur Heart J. 2018 Jul 21;39(28):2635-2642. doi: 10.1093/eurheartj/ehy107. PMID: 29546396.
Everett RJ, et al. Timing of intervention in aortic stenosis: a review of current and future strategies. Heart Epub 2018 doi:10.1136/heartjnl-2017-312304
Modified from Lester SJ, Heilbron B, Gin K, Dodek A, Jue J. The natural history and rate of progression of aortic stenosis. Chest. April 1998;113(4):1109-1114.
Carabello BA, Paulus WJ. Aortic stenosis. Lancet. March 14, 2009;373(9667):956-966.
McCarthy CP, Phelan D, Griffin B. When does asymptomatic aortic stenosis warrant surgery? Assessment techniques. Cleve Clin J Med. April 2016;83(4):271-280.
Brennan JM. Under-treatment of Aortic Stenosis in the United States. Presented at TVT 2019; Chicago, IL.
Medtronic data on file #2.
Schwarz F, Baumann P, Manthey J, et al. The effect of aortic valve replacement on survival. Circulation. November 1982;66(5):1105-1110.
Vahanian, A., Beyersdorf, F., et al. (2021), 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery European Heart Journal, 2021;, ehab395, https://doi.org/10.1093/eurheartj/ehab395.
Gaede L, Sitges M, Neil J, et al. European heart health survey 2019. Clin Cardiol. 2020;1–8. https://doi.org/10.1002/clc.23478