- Understanding of the basic issues related to the management of patients with aortic stenosis
- Discussion of difficult topics about aortic stenosis like the ‘low gradient/low flow aortic stenosis’
- New diagnostic and classification issues
- Progress and questions about the last developments of TAVI
This webinar was based on the presentation and discussion of two difficult clinical cases of AS patients.
- The first case was a patient with Low-Gradient symptomatic AS with an Aortic Area < 1 cm2. The discussion focused on the necessity to check for errors in measurement and correlation to body surface of the area. It was also discussed the need for further investigations such as an exercise test (not indicated in symptomatic but only in asymptomatic patients) In this case it is better to do a Dobutamine ECHO. Moreover, the measurement of calcium score with CT and the measurement of LVOT diameter are important while the utility of a TEE is less so.
- The second case was a severe AS in an asymptomatic ‘lower’ risk patient with previous chest radiotherapy for Hodgkin disease. The speakers also discussed the presence of symptoms and the related mortality and morbidity: prognosis is improved by treatment only when symptoms are present. Also the higher the gradient, the higher the related event rates, an intervention in asymptomatic subjects has unproven results. If aortic calcification is present, TAVI is the better choice for intervention but mitral calcification may complicate TAVI with a poor outcome. However TAVI is to be preferred over surgical replacement (SAVR) in cases of previous irradiation and thoracotomies, porcelain aorta, not relevant mitral regurgitation and patient wishes.