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The Surge

Clinical, training, product and patient outcome resources for cardiac surgeons and their heart team partners

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Medical Professional touching digital screen with a heart
Medical Professional touching digital screen with a heart
January 23, 2023

Timely Evaluation for Surgical Treatment of Aortic Valve Disease

Grandmother, mother, daughter
Grandmother, mother, daughter
Grandmother, mother, daughter

Here is a quick overview of the variables to consider when deciding if it is time for surgical treatment of aortic valve disease (AVD). This article will review outcomes for untreated or medically managed AVD patients, 2020 ACC/AHA guideline treatment recommendations, and when early treatment referral is appropriate.

Time is of the essence...

The pathology of aortic valve disease (AVD) typically develops over many years, and symptoms may not appear until the condition is severe. When symptoms develop, the rates of morbidity and mortality among patients are high.1

If AVD is left untreated or medically managed...

If AVD is left untreated or medically managed
If AVD is left untreated or medically managed
If AVD is left untreated or medically managed

2020 ACC/AHA Guideline recommendations for treatment of AVD5

Aortic regurgitation: Surgical aortic valve replacement (SAVR) is recommended for the treatment of symptomatic severe aortic regurgitation and asymptomatic chronic severe AR with left ventricular (LV) systolic dysfunction.

Aortic stenosis: SAVR is recommended for patients who have symptomatic or asymptomatic severe AS with LV dysfunction and are < 65 yrs of age or have a life expectancy > 20 years.

Proportion of patients
Proportion of patients
Proportion of patients

Among aortic valve replacement options, SAVR is the only guideline-directed treatment indicated to treat both AS and AR.

Timely evaluation can lead to timely intervention for patients...

The current convention for treating asymptomatic severe AVD is to provide treatment once symptoms develop. However, advances in surgical techniques and aortic valve prostheses may help change this.8

Referral for SAVR

SAVR treatment is a class 1 indication (ie, is strongly recommended) for patients who have asymptomatic severe AR with LV systolic dysfunction and for patients who have asymptomatic severe AS. Guidelines suggest that postoperative outcomes are better when surgery is performed early or before the onset of symptoms.5

Referral for SAVR
Referral for SAVR
Referral for SAVR

For additional information on surgical aortic valves:

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References

  1. Wenn P, Zeltser R. StatPearls [Internet]. 2021.
  2. Griffin B. Manual of Cardiovascular Medicine. 2013;1:238-355.
  3. Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Circulation. 1999;99:1851-1857.
  4. Strange G, Stewart S, Celermajer D, et al. J Am Coll Cardiol. 2019;74(15):1851-1863.
  5. Otto CM, Nishimura RA, Bonow RO, et al. J Am Coll Cardiol. 2021;77(4):e25-e197.
  6. Thourani VH, Brennan JM, Edelman JJ, et al. Struct Heart. 2021;5(6):608-618.
  7. Matthew BJ, Leon MB, Sheridan P, et al. J Am Heart Assoc. 2020;9(16):e015879.
  8. Kang DH, Park SJ, Lee SA, et al. N Engl J Med. 2020;382(2): 111-119.
Important Safety Information

Important Safety Information

INSPIRIS RESILIA Aortic Valve

Indications: For use in replacement of native or prosthetic aortic heart valves.

Contraindications: There are no known contraindications with the use of the INSPIRIS RESILIA aortic valve.

Complications and Side Effects: Thromboembolism, valve thrombosis, hemorrhage, hemolysis, regurgitation, endocarditis, structural valve deterioration, nonstructural dysfunction, stenosis, arrhythmia, transient ischemic attack/stroke, congestive heart failure, myocardial infarction, any of which could lead to reoperation, explantation, permanent disability, and death.

Warnings: DO NOT ADJUST THE VALVE DIAMETER BY EXPANDING THE BAND PRIOR TO OR DURING IMPLANTATION OF THE SURGICAL VALVE. The expandable band is not designed to allow for compression or expansion during implantation of the surgical valve. This will cause damage to the valve and may result in aortic incompetence. DO NOT PERFORM STAND-ALONE BALLOON AORTIC VALVULOPLASTY PROCEDURES ON THIS VALVE FOR THE SIZES 19-25 mm as this may expand the valve causing aortic incompetence, coronary embolism or annular rupture. Valve-in-valve sizing in the INSPIRIS valve has only been tested with specific Edwards transcatheter heart valves. Use of other transcatheter valves may result in embolization of transcatheter devices anchored within or result in annular rupture.

CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information.

Edwards, Edwards Lifesciences, the stylized E logo, INSPIRIS, INSPIRIS RESILIA, and RESILIA are trademarks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.

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