YOUR EVALUATION MATTERS
Use the SAS Patient Pathway Tool to help identify patients who are most suitable for treatment.
Download the SAS Patient Pathway ToolI TRUSTED MY HEART VALVE TEAM
I PUT MY TRUST
IN TAVR
IN TAVR
RICK|REAL TAVR PATIENT AND CARDIAC SURGEON
Your patients trust you to know when to act1
Your patients with symptomatic severe aortic stenosis (sSAS) have a chance for optimal outcomes with TAVR—including low-risk patients.2 Explore the broadened eligibility of TAVR.
Anne | Age 81: LG-LEF
Severe AS, symptoms include presyncope
About Anne
Anne is a colon cancer survivor who has never missed a monthly video chat with friends from her patient support group.
Medical history
Anne was diagnosed after being admitted to the emergency department upon feeling faint at a family dinner. She received an echo several years ago but AS was not identified; only gradient was considered.
Comorbidities3-5
Atrial fibrillation, CKD, and hypertension
- BP: 138/70 mmHg
Medications6,7
Hydrochlorothiazide, amlodipine, metoprolol, and rivaroxaban
AS=aortic stenosis; BP=blood pressure; CKD=chronic kidney disease; LG-LEF=low gradient, low ejection fraction.
AVA8,9
0.8 cm2
Gradient8,9
26 mmHg
LVEF8,9
37%
LVSVi10
30 mL/m2
Peak velocity8,9
2.8 m/s
Would you conduct further evaluation of
ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVA=aortic valve area; BP=blood pressure; LG-LEF=low gradient, low ejection fraction; LVEF=left ventricular ejection fraction; LVSVi=left ventricular stroke volume index.
Diagnosis:
Severe AS
Stage D2
Intermediate surgical risk3
Treatment considerations
AVR is associated with a survival benefit in patients with LG-LEF sSAS.8 Furthermore, TAVR is associated with improved survival in patients with sSAS and CKD regardless of stage and protects from further decline in renal function over one year of follow-up.4,5,11,12 Patients with D2 LG subtype have a class I indication for AVR in the ACC/AHA Guidelines.9
Comorbidities should not act as barriers to referring appropriate patients with sSAS to a Heart Valve Team.13
ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; BP=blood pressure; CKD=chronic kidney disease; LG-LEF=low gradient, low ejection fraction.
Charles | Age 67: HG-NEF
Severe AS, symptoms include fatigue and dyspnea
About Charles
Charles is a former high school teacher and swim coach who recently retired after 42 years.
Medical history
Charles was diagnosed with moderate AS after a heart murmur was detected and received regular follow-up. He initially denied symptoms, but upon further questioning revealed that he stopped swimming for exercise because he felt tired and short of breath with even moderate exertion.
Comorbidities2
Diabetic nephropathy and coronary artery disease
Medications14-16
Metformin, sulfonylurea, simvastatin, and empagliflozin
AS=aortic stenosis; HG=high gradient, normal ejection fraction.
AVA8,9
0.5 cm2
Gradient8,9
52 mmHg
LVEF8,9
66%
Peak velocity8,9
4.3 m/s
Would you conduct further evaluation of
AS=aortic stenosis; AVA=aortic valve area; HG-NEF=high gradient, normal ejection fraction; LVEF=left ventricular ejection fraction; SAS=severe aortic stenosis.
Diagnosis:
Severe AS
Stage D1
Low surgical risk2
Treatment considerations
AVR is associated with a survival benefit in patients with HG-NEF sSAS.8 Patients with D1 subtype have a class I indication for AVR in the ACC/AHA Guidelines.9
Comorbidities should not act as barriers to referring appropriate patients with sSAS to a Heart Valve Team.13
ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; HG-NEF=high gradient, normal ejection fraction.
Marie | Age 75: LG-NEF
Severe AS, symptoms include dyspnea
About Marie
Marie is a grandmother of 8 who enjoys hosting Sunday dinners for her family.
Medical history
Marie was diagnosed upon referral to a Heart Valve Team, where MSCT determined her calcium score was 1683 Agatston units.10 She received an echo previously, but AS was not indicated and gradient was noted as normal.
Comorbidities
Asthma and osteoporosis
- Uses a walker due to hip fracture
Medications18-21
Fluticasone inhaler, albuterol rescue inhaler, and alendronate
AS=aortic stenosis; LG-NEF=low gradient, normal ejection fraction; MSCT=multislice computed tomography.
AVA8,9
0.9 cm2
Peak velocity8,9
3.5 m/s
LVEF8,9
70%
LVSVi10
27 mL/m2
Gradient8,9
25 mmHg
Would you conduct further evaluation of
ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVA=aortic valve area; LFLG=low flow, low gradient; LG-NEF=low gradient, normal ejection fraction; LVEF=left ventricular ejection fraction; LVSVi=left ventricular stroke volume index.
Diagnosis:
Severe AS
Stage D3
Low surgical risk2
Treatment considerations
AVR is associated with a survival benefit in patients with
Comorbidities should not act as barriers to referring appropriate patients with sSAS to a Heart Valve Team.13
ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; LG-NEF=low gradient, normal ejection fraction.
Earlier referral to a Heart Valve Team is the first crucial step to lifesaving outcomes for your sSAS patients23
These are portrayals of typical TAVR patients and not real patients.
Peer Perspectives:
Treating aortic stenosis at the right time
“It really does negatively impact the patient when we wait to treat them.”
-
Antonio H. Frangieh, MD
Interventional Cardiologist
Interventional Cardiologist
Help your patients understand the differences between TAVR and SAVR
Using visual aids such as this side-by-side chart gives your patients with SAS a clearer understanding of their treatment options, while reinforcing their role in shared decision-making.
SAVR
TAVR
Available for all surgical risk patients (except prohibitive risk)9
OR
Available for severe, symptomatic calcific aortic stenosis patients, independent of surgical risk
More invasive procedure
OR
Less invasive procedure24
Requires sternotomy
OR
The most common approach is the transfemoral approach
Requires stopping the heart and connecting the patient to a blood-pumping machine
OR
Does not require stopping the heart
Requires general anesthesia
OR
May be performed using conscious sedation
On average, may take ~4 hours*
OR
On average, may take ~1 hour*24
With TAVR, most patients have a short recovery time and go home the next day
*The PARTNER 3 Trial, transcatheter or surgical aortic valve replacement in low-risk patients with aortic stenosis.
COMORBIDITIES... OR SYMPTOMS OF SAS?
Or is it their age and/or preexisting health conditions? Find out why comorbidities should not delay referrals.13
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References:
1.Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011.
2.Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705.
3.Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609-1620.
4.Mentias A, Desai MY, Saad M, et al. Management of aortic stenosis in patients with end-stage renal disease on hemodialysis. Circ Cardiovasc Interv. 2020;13(8):e009252.
5.Steinmetz T, Witberg G, Chagnac A, et al. Transcatheter aortic valve implantation versus conservative treatment in chronic kidney disease patients. EuroIntervention. 2018;14(5):e503-e510.
6.Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156.
7.Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.
8.Li SX, Patel NK, Flannery LD, et al. Trends in utilization of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2022;79(9):864-877.
9.Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of
Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227.
10.Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372-392.
11.Bohbot Y, Candellier A, Diouf M, et al. Severe aortic stenosis and chronic kidney disease: outcomes and impact of aortic valve replacement. J Am Heart Assoc. 2020;9(19):e017190.
12.Cubeddu RJ, Asher CR, Lowry AM, et al. Impact of transcatheter aortic valve replacement on severity of chronic kidney disease. J Am Coll Cardiol. 2020;76(12):1410-1421.
13.Feldman DR, Romashko MD, Koethe B, et al. Comorbidity burden and adverse outcomes after transcatheter aortic valve replacement. J Am Heart Assoc. 2021;10(10):e018978.
14.Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e563-e595.
15.American Diabetes Association. Standards of care in diabetes—2023 abridged for primary care providers. Clin Diabetes. 2022;41(1):4-31.
16.Boehringer Ingelheim Pharmaceuticals. Jardiance (empagliflozin tablets). U.S. Food and Drug Administration. Updated September 2023. Accessed September 26, 2024. https://content.boehringer-ingelheim.com/DAM/7d9c411c-ec33-4f82-886f-af1e011f35bb/jardiance-us-pi.pdf
17.Otto CM. Timing of aortic valve surgery. Heart. 2000;84(2):211-218.
18.Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated July 2023. Accessed September 27, 2024. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf
19.Medline Plus. Alendronate. Updated October 15, 2023. Accessed September 27, 2024. https://medlineplus.gov/druginfo/meds/a601011.html
20.Medline Plus. Fluticasone oral inhalation. Updated July 20, 2024. Accessed September 27, 2024. https://medlineplus.gov/druginfo/meds/a601056.html
21.Medline Plus. Albuterol oral inhalation. Updated February 15, 2016. September 27, 2024. https://medlineplus.gov/druginfo/meds/a682145.html
22.Hung J, Klassen SL, Bermejo J, Chambers JB. Take home messages with cases from focused update on echocardiographic assessment of aortic stenosis. Heart. 2018;104(16):1317-1322.
23.Lancellotti P, Magne J, Dulgheru R, et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol. 2018;3(11):1060-1068.
24.Cleveland Clinic. Transcatheter aortic valve replacement. Updated May 3, 2024. Accessed September 27, 2024. https://my.clevelandclinic.org/health/treatments/17570-transcatheter-aortic-valve-replacement-tavr
Patients and/or clinicians quoted on this website have received compensation from Edwards Lifesciences.