Topics:
Valvular Heart Diseases
Session number: 920000
Session title: New concepts in the treatment of Aortic Valve disease
Authors: Maisano, F. Milan, Italy
As life expectancy increases, a growing number of patients with calcific aortic stenosis and comorbidities are going to need valve replacement. However, according to the Euro Heart Survey, 1/3 of elderly patients with symptomatic severe aortic stenosis are not currently referred to surgery. Mainly surgery is denied because of comorbidities, or because risk is considered to be too high.
But, “how much of risk is too high” is the matter of current discussion. Operative risk is not only depending on patients characteristics, but also on the expertise of the individual surgeons and institutions. On the other hand, new transcatheter technologies are not free from procedural risks, while their durability is still unknown.
“Surgery is evolving to deal with this new growing population” – Dr Oto (Izmir, Turkey) said. Minimally invasive surgery is coupled with advanced perioperative care, specifically designed to lower the risk of elderly patients. New surgical procedures are implementing transcatheter technologies into the more conventional surgical milieu. Hibrid approaches involve sutureless aortic valve implantation, using self expandable tissue valves and transapical closed heart transcatheter valve implantation without the use of cardiopulmonary bypass. Clinical experience with these new approaches is still initial, but results, reported by Dr F Van Praet (Aalst, Belgium) and Dr F Beyersdorf (Freiburg, Denmark), are encouraging.
Indications for these technologies are still to be defined: strict selection criteria for transcatheter AVR (either surgical or interventional) are needed. We need scoring systems specifically designed to predict procedural risks of both surgical and interventional treatment of aortic stenosis. The ideal scoring system – Dr A Vahanian (Paris, France) said - should be valve disease specific, built and tested from a subset of patients including those at high surgical risk, it should be applicable in standard practice and should be easy to use, and being able to predict both surgical and spontaneous outcomes.
Conclusion
New technologies to treat aortic valve stenosis are introducing new opportunities and new challenges. The future of aortic valve treatment will benefit from a close collaboration between professionals, including general practitioners, cardiologists, interventionalists and surgeons.
The content of this article reflects the personal opinion of the
author/s and is not necessarily the official position of the
European Society of Cardiology.