Concomitant Severe Aortic Stenosis Research Articles

Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis

Carotid artery stenting (CAS) prior to open-heart surgery may be a useful approach to minimise the risk of neurologic events in patients undergoing aortic valve replacement (AVR). All patients referred for carotid intervention at our institution between 1998 and 2005 with concomitant severe aortic stenosis (AS) (aortic valve area <1.0 cm2) were included. Data were obtained prospectively and confirmed by chart review. The primary endpoint was all-cause mortality at 30-days after CAS or AVR. Secondary endpoints included incidence of stroke, transient ischaemic attack (TIA), and myocardial infarction (MI) at 30-days after CAS or AVR. Patients were followed-up at 30-days, six months, and annually thereafter. Of the 829 patients who underwent CAS, 52 had severe AS. Carotid stenting in 28 (54%) of the patients was attempted using embolic protection devices. Three patients (6%) died <30 days after carotid stenting, and two (4%) died >30 days after carotid stenting but prior to aortic valve replacement. At one year after CAS, a total of nine patients had died. There were a total of 19 deaths (37%) over a median follow-up of 3.8 years. One patient (2%) suffered a TIA during carotid stenting; at 30-days and 1-year there were no strokes in the CAS group. There were no MI's. AVR was performed in 29 patients (56%), and at 30-days and 1-year there were no strokes or deaths noted in those patients. In patients with severe AS, CAS can be accomplished effectively and with a low rate of stroke, MI, and death.

Risk stratification and management of aortic stenosis with concomitant left ventricular dysfunction

Aortic stenosis is a common clinical problem. The development of symptoms usually precedes the development of left ventricular (LV) dysfunction. Therefore, patients with concomitant severe aortic stenosis and LV dysfunction comprise a minority with this condition, albeit a clinically challenging group to manage. Because the only proven therapy for aortic stenosis is surgical valve replacement, the approach to the management of a patient with aortic stenosis and LV dysfunction primarily centers on risk stratification and the decision of whether to operate. Patients with aortic stenosis and low transvalvular gradients constitute a distinctly high-risk group, particularly when evidence of contractile reserve is absent after challenge with dobutamine. In the absence of any effective medical therapies, it is increasingly clear that even high-risk patients lacking contractile reserve may benefit from surgical valve replacement. However, evolving experimental percutaneous solutions may offer new management options for high-risk patients in the future.