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/* Indications for Intervention in Aortic Stenosis and Recommendations for the Choice of Intervention Mode{{cite journal|last1=Baumgartner|first1=Helmut|last2=Falk|first2=Volkmar|last3=Bax|first3=Jeroen J|last4=De Bonis|first4=Michele|last5=Hamm|first5...
Sabawoon Mirwais (talk | contribs)
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4,937 edits
/* Indications for Intervention in Aortic Stenosis and Recommendations for the Choice of Intervention Mode{{cite journal|last1=Baumgartner|first1=Helmut|last2=Falk|first2=Volkmar|last3=Bax|first3=Jeroen J|last4=De Bonis|first4=Michele|last5=Hamm|first5...
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*<sup>a</sup>In patients with a small valve area but low gradient despite preserved LVEF, explanations for this finding other than the presence of severe aortic stenosis are frequent and must be carefully excluded.
*<sup>a</sup>In patients with a small valve area but low gradient despite preserved LVEF, explanations for this finding other than the presence of severe aortic stenosis are frequent and must be carefully excluded.
*<sup>b</sup>STS score (calculator: http://riskcalc.sts.org/stswebriskcalc/#/calculate); EuroSCORE II (calculator: http://www.euroscore.org/calc.html); logistic EuroSCORE I (calculator:http://www.euroscore.org/calcge.html); scores have major limitations for practical use in this setting by insufficiently considering disease severity and not including major risk factors such as frailty, porcelain aorta, chest radiation, etc. EuroSCORE I markedly overestimates 30-day mortality and should therefore be replaced by the better-performing EuroSCORE II with this regard; it is nevertheless provided here for comparison, as it has been used in many TAVR studies/registries and may still be useful to identify the subgroups of patients for decision between intervention modalities and to predict 1-year mortality.
*<sup>b</sup>STS score (calculator: http://riskcalc.sts.org/stswebriskcalc/#/calculate); EuroSCORE II (calculator: http://www.euroscore.org/calc.html); logistic EuroSCORE I (calculator:http://www.euroscore.org/calcge.html); scores have major limitations for practical use in this setting by insufficiently considering disease severity and not including major risk factors such as frailty, porcelain aorta, chest radiation, etc. EuroSCORE I markedly overestimates 30-day mortality and should therefore be replaced by the better-performing EuroSCORE II with this regard; it is nevertheless provided here for comparison, as it has been used in many TAVR studies/registries and may still be useful to identify the subgroups of patients for decision between intervention modalities and to predict 1-year mortality.
*<sup>c</sup>eModerate aortic stenosis is defined as a valve area of 1.0–1.5 cm2 or a mean aortic gradient of 25–40 mmHg in the presence of normal flow conditions. However, clinical judgement is required.
*<sup>c</sup>Moderate aortic stenosis is defined as a valve area of 1.0–1.5 cm2 or a mean aortic gradient of 25–40 mmHg in the presence of normal flow conditions. However, clinical judgement is required.
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Revision as of 21:52, 18 February 2020
Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]; Rim Halaby; Usama Talib, BSc, MD [3]

Overview

Once a patient with aortic stenosis becomes symptomatic, aortic valve replacement should be performed as long as the patient can tolerate surgery and has no co-morbidities. If severe left ventricular dysfunction is present in the setting of aortic stenosis, it is of utmost importance to differentiate between true severe aortic stenosis and pseudo-severe aortic stenosis as these two entities have different pathophysiologies and different outcomes after aortic valve replacement.[1] Medical therapy reduces symptoms but does not prolong life. If a patient has extensive co-morbidities, transcatheter aortic valve implantation can be considered. Aortic valvuloplasty can be considered in those patients who are too sick for surgery or transcatheter aortic valve implantation.[2]

General Approach

The general approach to treating Aortic Valve Stenosis has the following important aspects.[3]

Shown below is an algorithm summarizing the management of symptomatic and asymptomatic patients with aortic stenosis and the indications for AVR. If the patient does not meet any of the decision pathways in the algorithm, regular monitoring is recommended and AVR is not indicated.[5][6]

Abbreviations: AVR: Aortic valve replacement; LVEF: Left ventricular ejection fraction; ΔPmean: mean pressure gradient; Vmax: maximum velocity

 
 
 
 
 
 
 
 
 
 
 
Abnormal aortic valve
AND
Reduction in systolic opening
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Severe aortic stenosis:
Vmax≥4m/s
AND
ΔPmean≥40 mmHg
 
 
 
 
 
 
 
 
 
 
Vmax3-3.9 m/s
AND
ΔPmean20-39 mmHg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient symptomatic?
 
 
 
 
 
 
 
 
 
 
Is the patient symptomatic?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
(Stage D1)
 
 
 
 
 
No
(Stage C)
 
 
 
Yes
 
 
 
No
(Stage B)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LVEF <50%
(Stage C2)
 
 
 
 
Is LVEF <50%?
 
 
 
The patient is undergoing
another cardiac surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The patient is undergoing
another cardiac surgery
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vmax≥5m/s
AND
ΔPmean≥60 mmHg
(Very severe stage C1)
AND
Low surgical risk
 
 
Dobutamine stress echocardiography:
Aortic valve area ≤1 cm2
AND
Vmax≥4 ms
(Stage D2)
 
Aortic valve area ≤1 cm2
AND
LVEF ≥50%
(Stage D3)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal exercise treadmill test
 
 
 
 
 
 
 
The symptoms are likely
the result of the aortic stenosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ΔVmax>0.3 m/s/y
AND
Low surgical risk
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AVR (Class I)
 
AVR (Class IIa)
 
AVR (Class IIb)
 
AVR (Class IIa)
 
AVR (Class IIa)
 
AVR (Class IIa)

Shown below is an algorithm summarizing the approach to patients with low flow, low gradient aortic stenosis.[1]

Abbreviations: AVR: Aortic valve replacement; EOA: Effective orifice area; ΔPmean: mean pressure gradient

 
 
Ultrasound evaluation of aortic stenosis
Effective orifice area (EOA)≤ 1 cm2
Pressure gradient (ΔP)<40 mmHg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low grade low flow aortic stenosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal left ventricular ejection fraction
 
Left ventricular ejection fraction≤ 40-50%[6]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No specific recommendations:
- Surgical AVR, or
- Transcather AVR, or
- Medical treatment
 
 
 
 
 
 
 
 
 
 
 
Dobutamine stress test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increase in stroke volume by ≥ 20%
 
Increase in stroke volume by <20%
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of left ventricular flow reserve
 
Absence of left ventricular flow reserve
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ΔP≥40
EOA<1-1.2
 
ΔP<40
EOA≥1-1.2
 
EOA<1-1.2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
True severe aortic stenosis
 
Pseudo-severe aortic stenosis
 
True severe aortic stenosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical AVR
with/without CABG
 
Medical treatment
Close follow up
 
Transcather AVR


Available Therapeutic Options

Following are some of the available therapeutic options for Aortic Stenosis.[3][7]

ESC/EACTS Guidelines

Indications for Intervention in Aortic Stenosis and Recommendations for the Choice of Intervention Mode[8]


Symptomatic Aortic Stenosis Class of Recommendation Level of Evidence
Intervention is indicated in symptomatic patients with severe, high-gradient aortic stenosis (mean gradient ≥ 40 mmHg or peak velocity ≥ 4.0 m/s)[9][10][11] I B
Intervention is indicated in symptomatic patients with severe low-flow, low-gradient (< 40 mmHg) aortic stenosis with reduced ejection fraction and evidence of flow (contractile) reserve excluding pseudosevere aortic stenosis I C
Intervention should be considered in symptomatic patients with low-flow, low-gradient (< 40 mmHg) aortic stenosis with normal ejection fraction after careful confirmation of severe aortic stenosisa IIa C
Intervention should be considered in symptomatic patients with low-flow, low-gradient aortic stenosis and reduced ejection fraction without flow (contractile) reserve, particularly when CT calcium scoring confirms severe aortic stenosis IIa C
Intervention should not be performed in patients with severe comorbidities when the intervention is unlikely to improve quality of life or survival III C
Choice of Intervention in Symptomatic Aortic Stenosis
Aortic valve interventions should only be performed in centres with both departments of cardiology and cardiac surgery on site and with structured collaboration between the two, including a Heart Team (heart valve centres) I C
The choice for intervention must be based on careful individual evaluation of technical suitability and weighing of risks and benefits of each modality. In addition, the local expertise and outcomes data for the given intervention must be taken into account I C
SAVR is recommended in patients at low surgical risk (STS or EuroSCORE II < 4% or logistic EuroSCORE I < 10%b and no other risk factors not included in these scores, such as frailty, porcelain aorta, sequelae of chest radiation)[11] I B
TAVI is recommended in patients who are not suitable for SAVR as assessed by the Heart Team[9][12] I B
In patients who are at increased surgical risk (STS or EuroSCORE II ≥ 4% or logistic EuroSCORE I ≥ 10%b or other risk factors not included in these scores such as frailty, porcelain aorta, sequelae of chest radiation), the decision between SAVR and TAVR should be made by the Heart Team according to the individual patient characteristics, with TAVR being favored in elderly patients suitable for transfemoral access[9][12][13][14][15][16][17][18][19][20] I B
Balloon aortic valvotomy may be considered as a bridge to SAVR or TAVR in hemodynamically unstable patients or in patients with symptomatic severe aortic stenosis who require urgent major non-cardiac surgery IIb C
Balloon aortic valvotomy may be considered as a diagnostic means in patients with severe aortic stenosis or other potential causes for symptoms (i.e. lung disease) and in patients with severe myocardial dysfunction, pre-renal insufficiency, or other organ dysfunction that may be reversible with balloon aortic valvotomy when performed in centers that can escalate to TAVR IIb C
Asymptomatic Patients With Severe Aortic Stenosis (Refers Only to Patients Eligible for Surgical Valve Replacement)
SAVR is indicated in asymptomatic patients with severe aortic stenosis and systolic LV dysfunction (LVEF < 50%) not due to another cause I C
SAVR is indicated in asymptomatic patients with severe aortic stenosis and an abnormal exercise test showing symptoms on exercise clearly related to aortic stenosis I C
SAVR should be considered in asymptomatic patients with severe aortic stenosis and an abnormal exercise test showing a decrease in blood pressure below baseline IIa C
SAVR should be considered in asymptomatic patients with normal ejection fraction and none of the above-mentioned exercise test abnormalities if the surgical risk is low and one of the following findings is present:
  • Very severe aortic stenosis defined by a Vmax > 5.5 m/s
  • Severe valve calcification and a rate of Vmax progression ≥ 0.3 m/s/year
  • Markedly elevated BNP levels (> threefold age- and sex-corrected normal range) confirmed by repeated measurements without other explanations
  • Severe pulmonary hypertension (systolic pulmonary artery pressure at rest > 60 mmHg confirmed by invasive measurement) without other explanation
 IIa C
Concomitant Aortic Valve Surgery at the Time of Other Cardiac/Ascending Aorta Surgery
SAVR is indicated in patients with severe aortic stenosis undergoing CABG or surgery of the ascending aorta or of another valve I C
SAVR should be considered in patients with moderate aortic stenosisc undergoing CABG or surgery of the ascending aorta or of another valve after Heart Team decision IIa C
BNP = B-type natriuretic peptide; CABG = coronary artery bypass grafting; CT = computed tomography; EuroSCORE = European System for Cardiac Operative Risk Evaluation; LV = left ventricular; LVEF = left ventricular ejection fraction; SAVR = surgical aortic valve replacement; STS = Society of Thoracic Surgeons; TAVR = transcatheter aortic valve replacement; Vmax = peak transvalvular velocity
  • aIn patients with a small valve area but low gradient despite preserved LVEF, explanations for this finding other than the presence of severe aortic stenosis are frequent and must be carefully excluded.
  • bSTS score (calculator: http://riskcalc.sts.org/stswebriskcalc/#/calculate); EuroSCORE II (calculator: http://www.euroscore.org/calc.html); logistic EuroSCORE I (calculator:http://www.euroscore.org/calcge.html); scores have major limitations for practical use in this setting by insufficiently considering disease severity and not including major risk factors such as frailty, porcelain aorta, chest radiation, etc. EuroSCORE I markedly overestimates 30-day mortality and should therefore be replaced by the better-performing EuroSCORE II with this regard; it is nevertheless provided here for comparison, as it has been used in many TAVR studies/registries and may still be useful to identify the subgroups of patients for decision between intervention modalities and to predict 1-year mortality.
  • cModerate aortic stenosis is defined as a valve area of 1.0–1.5 cm2 or a mean aortic gradient of 25–40 mmHg in the presence of normal flow conditions. However, clinical judgement is required.





References

  1. ↑ 1.0 1.1 Pibarot P, Dumesnil JG (2012). "Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction". J Am Coll Cardiol. 60 (19): 1845–53. doi:10.1016/j.jacc.2012.06.051. PMID 23062546.
  2. ↑ Franck Levy, Marcel Laurent, Jean Luc Monin, Jean Michel Maillet, Agnes Pasquet, Thierry Le Tourneau, Helene Petit-Eisenmann, Mauro Gori, Yannick Jobic, Fabrice Bauer, Christophe Chauvel, Alain Leguerrier & Christophe Tribouilloy (2008). "Aortic valve replacement for low-flow/low-gradient aortic stenosis operative risk stratification and long-term outcome: a European multicenter study". Journal of the American College of Cardiology. 51 (15): 1466–1472. doi:10.1016/j.jacc.2007.10.067. PMID 18402902. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
  4. ↑ Jean-Luc Monin, Jean-Paul Quere, Mehran Monchi, Helene Petit, Serge Baleynaud, Christophe Chauvel, Camelia Pop, Patrick Ohlmann, Claude Lelguen, Patrick Dehant, Christophe Tribouilloy & Pascal Gueret (2003). "Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics". Circulation. 108 (3): 319–324. doi:10.1161/01.CIR.0000079171.43055.46. PMID 12835219. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
  6. ↑ 6.0 6.1 Nishimura, R. A.; Otto, C. M.; Bonow, R. O.; Carabello, B. A.; Erwin, J. P.; Guyton, R. A.; O'Gara, P. T.; Ruiz, C. E.; Skubas, N. J.; Sorajja, P.; Sundt, T. M.; Thomas, J. D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.
  7. ↑ Vahl TP, Kodali SK, Leon MB (2016). "Transcatheter Aortic Valve Replacement 2016: A Modern-Day "Through the Looking-Glass" Adventure". J Am Coll Cardiol. 67 (12): 1472–87. doi:10.1016/j.jacc.2015.12.059. PMID 27012409.
  8. ↑ Baumgartner, Helmut; Falk, Volkmar; Bax, Jeroen J; De Bonis, Michele; Hamm, Christian; Holm, Per Johan; Iung, Bernard; Lancellotti, Patrizio; Lansac, Emmanuel; Rodriguez Muñoz, Daniel; Rosenhek, Raphael; Sjögren, Johan; Tornos Mas, Pilar; Vahanian, Alec; Walther, Thomas; Wendler, Olaf; Windecker, Stephan; Zamorano, Jose Luis; Roffi, Marco; Alfieri, Ottavio; Agewall, Stefan; Ahlsson, Anders; Barbato, Emanuele; Bueno, Héctor; Collet, Jean-Philippe; Coman, Ioan Mircea; Czerny, Martin; Delgado, Victoria; Fitzsimons, Donna; Folliguet, Thierry; Gaemperli, Oliver; Habib, Gilbert; Harringer, Wolfgang; Haude, Michael; Hindricks, Gerhard; Katus, Hugo A; Knuuti, Juhani; Kolh, Philippe; Leclercq, Christophe; McDonagh, Theresa A; Piepoli, Massimo Francesco; Pierard, Luc A; Ponikowski, Piotr; Rosano, Giuseppe M C; Ruschitzka, Frank; Shlyakhto, Evgeny; Simpson, Iain A; Sousa-Uva, Miguel; Stepinska, Janina; Tarantini, Giuseppe; Tchétché, Didier; Aboyans, Victor; Windecker, Stephan; Aboyans, Victor; Agewall, Stefan; Barbato, Emanuele; Bueno, Héctor; Coca, Antonio; Collet, Jean-Philippe; Coman, Ioan Mircea; Dean, Veronica; Delgado, Victoria; Fitzsimons, Donna; Gaemperli, Oliver; Hindricks, Gerhard; Iung, Bernard; Jüni, Peter; Katus, Hugo A; Knuuti, Juhani; Lancellotti, Patrizio; Leclercq, Christophe; McDonagh, Theresa; Piepoli, Massimo Francesco; Ponikowski, Piotr; Richter, Dimitrios J; Roffi, Marco; Shlyakhto, Evgeny; Simpson, Iain A; Zamorano, Jose Luis; Kzhdryan, Hovhannes K; Mascherbauer, Julia; Samadov, Fuad; Shumavets, Vadim; Camp, Guy Van; Lončar, Daniela; Lovric, Daniel; Georgiou, Georgios M; Linhartova, Katerina; Ihlemann, Nikolaj; Abdelhamid, Magdy; Pern, Teele; Turpeinen, Anu; Srbinovska-Kostovska, Elizabeta; Cohen, Ariel; Bakhutashvili, Zviad; Ince, Hüseyin; Vavuranakis, Manolis; Temesvári, András; Gudnason, Thorarinn; Mylotte, Darren; Kuperstein, Rafael; Indolfi, Ciro; Pya, Yury; Bajraktari, Gani; Kerimkulova, Alina; Rudzitis, Ainars; Mizariene, Vaida; Lebrun, Frédéric; Demarco, Daniela Cassar; Oukerraj, Latifa; Bouma, Berto J; Steigen, Terje Kristian; Komar, Monika; De Moura Branco, Luisa Maria; Popescu, Bogdan A; Uspenskiy, Vladimir; Foscoli, Marina; Jovovic, Ljiljana; Simkova, Iveta; Bunc, Matjaz; de Prada, José Antonio Vázquez; Stagmo, Martin; Kaufmann, Beat Andreas; Mahdhaoui, Abdallah; Bozkurt, Engin; Nesukay, Elena; Brecker, Stephen J D (2017). "2017 ESC/EACTS Guidelines for the management of valvular heart disease". European Heart Journal. 38 (36): 2739–2791. doi:10.1093/eurheartj/ehx391. ISSN 0195-668X.
  9. ↑ 9.0 9.1 9.2 Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S (October 2010). "Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery". N. Engl. J. Med. 363 (17): 1597–607. doi:10.1056/NEJMoa1008232. PMID 20961243.
  10. ↑ Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M, Maurer G, Baumgartner H (August 2000). "Predictors of outcome in severe, asymptomatic aortic stenosis". N. Engl. J. Med. 343 (9): 611–7. doi:10.1056/NEJM200008313430903. PMID 10965007.
  11. ↑ 11.0 11.1 Thourani VH, Suri RM, Gunter RL, Sheng S, O'Brien SM, Ailawadi G, Szeto WY, Dewey TM, Guyton RA, Bavaria JE, Babaliaros V, Gammie JS, Svensson L, Williams M, Badhwar V, Mack MJ (January 2015). "Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients". Ann. Thorac. Surg. 99 (1): 55–61. doi:10.1016/j.athoracsur.2014.06.050. PMID 25442986.
  12. ↑ 12.0 12.1 Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, Kleiman NS, Coselli JS, Gleason TG, Lee JS, Hermiller JB, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte J, Resar J, Aharonian V, Pfeffer T, Oh JK, Qiao H, Adams DH, Popma JJ (June 2016). "3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement". J. Am. Coll. Cardiol. 67 (22): 2565–74. doi:10.1016/j.jacc.2016.03.506. PMID 27050187.
  13. ↑ Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ (June 2011). "Transcatheter versus surgical aortic-valve replacement in high-risk patients". N. Engl. J. Med. 364 (23): 2187–98. doi:10.1056/NEJMoa1103510. PMID 21639811.
  14. ↑ Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Akin J, Davidson MJ, Svensson LG (June 2015). "5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial". Lancet. 385 (9986): 2477–84. doi:10.1016/S0140-6736(15)60308-7. PMID 25788234.
  15. ↑ Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK (May 2014). "Transcatheter aortic-valve replacement with a self-expanding prosthesis". N. Engl. J. Med. 370 (19): 1790–8. doi:10.1056/NEJMoa1400590. PMID 24678937.
  16. ↑ Thyregod H, Ihlemann N, Jørgensen TH, Nissen H, Kjeldsen BJ, Petursson P, Chang Y, Franzen OW, Engstrøm T, Clemmensen P, Hansen PB, Andersen LW, Steinbrüchel DA, Olsen PS, Søndergaard L (February 2019). "Five-Year Clinical and Echocardiographic Outcomes from the Nordic Aortic Valve Intervention (NOTION) Randomized Clinical Trial in Lower Surgical Risk Patients". Circulation. doi:10.1161/CIRCULATIONAHA.118.036606. PMID 30704298. Vancouver style error: initials (help)
  17. ↑ Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG (April 2016). "Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients". N. Engl. J. Med. 374 (17): 1609–20. doi:10.1056/NEJMoa1514616. PMID 27040324.
  18. ↑ Vinod H. Thourani, Susheel Kodali, Raj R. Makkar, Howard C. Herrmann, Mathew Williams, Vasilis Babaliaros, Richard Smalling, Scott Lim, S. Chris Malaisrie, Samir Kapadia, Wilson Y. Szeto, Kevin L. Greason, Dean Kereiakes, Gorav Ailawadi, Brian K. Whisenant, Chandan Devireddy, Jonathon Leipsic, Rebecca T. Hahn, Philippe Pibarot, Neil J. Weissman, Wael A. Jaber, David J. Cohen, Rakesh Suri, E. Murat Tuzcu, Lars G. Svensson, John G. Webb, Jeffrey W. Moses, Michael J. Mack, D. Craig Miller, Craig R. Smith, Maria C. Alu, Rupa Parvataneni, Ralph B. Jr D'Agostino & Martin B. Leon (2016). "Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis". Lancet (London, England). 387 (10034): 2218–2225. doi:10.1016/S0140-6736(16)30073-3. PMID 27053442. Unknown parameter |month= ignored (help)
  19. ↑ George C. M. Siontis, Fabien Praz, Thomas Pilgrim, Dimitris Mavridis, Subodh Verma, Georgia Salanti, Lars Sondergaard, Peter Juni & Stephan Windecker (2016). "Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials". European heart journal. 37 (47): 3503–3512. doi:10.1093/eurheartj/ehw225. PMID 27389906. Unknown parameter |month= ignored (help)
  20. ↑ Michael J. Reardon, Nicolas M. Van Mieghem, Jeffrey J. Popma, Neal S. Kleiman, Lars Sondergaard, Mubashir Mumtaz, David H. Adams, G. Michael Deeb, Brijeshwar Maini, Hemal Gada, Stanley Chetcuti, Thomas Gleason, John Heiser, Rudiger Lange, William Merhi, Jae K. Oh, Peter S. Olsen, Nicolo Piazza, Mathew Williams, Stephan Windecker, Steven J. Yakubov, Eberhard Grube, Raj Makkar, Joon S. Lee, John Conte, Eric Vang, Hang Nguyen, Yanping Chang, Andrew S. Mugglin, Patrick W. J. C. Serruys & Arie P. Kappetein (2017). "Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients". The New England journal of medicine. 376 (14): 1321–1331. doi:10.1056/NEJMoa1700456. PMID 28304219. Unknown parameter |month= ignored (help)

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