Acute Decompensated Aortic Stenosis: State of the Art Review |
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| Affiliation: | 1. Barts Heart Centre, St Bartholomew''s Hospital, London;2. Institute of Cardiovascular Science, University College London, London;3. Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA;4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;5. Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London;6. Yale University School of Medicine, New Haven, CT;7. Department of Neuroscience, Imaging and Clinical Sciences, G.d''Annunzio University of Chieti-Pescara, Chieti, Italy;8. Newham University Hospital, Barts Health NHS Trust, London;1. Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia;2. Department of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA;3. Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia;4. Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia;5. Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, Kingdom of Bahrain;6. Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia;7. Department of Cardiology, Madinah Cardiac Center, Madinah, kingdom of Saudi Arabia;8. Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, UAE;9. Department of of Internal Medicine, Gastroenterology Section, Gastroenterologist & Advanced Therapeutic Endoscopist, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia;10. Department of Cardiology, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia;11. Department of Cardiology, Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia;12. Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia;13. Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE;14. Department of Cardiology, Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia;15. Department of Cardiology, Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia;p. Cardiology Center of Excellence, Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia;q. Department of cardiology, Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia;r. Department of Cardiology, Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia;s. King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, kingdom of Saudi Arabia;t. Department of cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia;u. Department of Cardiology, king Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia;w. King Abdul Aziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia;x. Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt;y. Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia;z. Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Egypt;11. Department of Internal Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, MA;22. Faculty of Medicine, Tanta University, Tanta, Egypt;33. Department of Emergency Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia;1. Department of Cardiology, Central Japan International Medical Center, Gifu, Japan;2. Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan.;3. Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, 390-8621, Japan.;1. Internal Medicine, University of Texas Medical Branch, Galveston, TX;2. Cardiology, University of Texas Medical Branch, Galveston, TX;1. Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL?;2. Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL;3. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA;4. Department of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois Chicago, Chicago, IL?;5. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA;6. Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, São Carlos, SP, Brazil;7. Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia;8. Mayo Clinic, Rochester, Minnesota;9. Department of Cardiology, University "L. Vanvitelli" - Monaldi Hospital, Naples, Italy;10. Department of Biological Sciences, San Paolo Hospital, Cardiology Division, University of Milano School of Medicine, Milano, Italy;1. Department of Cardiothoracic Surgery, Chengdu Second People''s Hospital, Chengdu, Sichuan, China;2. Department of Anesthesiology, West China Hospital of Medicine, Sichuan University, Chengdu, Sichuan, China;3. Department of Emergency, Daping Hospital, Army Military Medical University, Chongqing, China;1. Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, TX.;2. Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH.;3. Division of Medicine, Forrest General Hospital, Hattiesburg, MS.;4. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch, Galveston, TX.;5. Division of Internal Medicine, University of Texas Medical Branch, Galveston, TX.;6. Department of Cardiology, Division of Internal Medicine, University of Texas Medical Branch, Galveston, TX. |
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| Abstract: | Aortic stenosis (AS) is a progressive disease that carries a poor prognosis. Patients are managed conservatively until satisfying an indication for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) based on AS severity and the presence of symptoms or adverse impact on the myocardium. Up to 1 in 3 TAVIs are performed for patients with acute symptoms of dyspnea at rest, angina, and/or syncope - termed acute decompensated aortic stenosis (ADAS) and require urgent aortic valve replacement. These patients have longer hospital length of stay, undergo physical deconditioning, and have a higher rate of acute kidney injury and mortality compared to stable patients with less severe symptoms. There is an urgent need to prevent ADAS and to deliver pathways to manage and improve ADAS-related outcomes. We provide here a contemporary review on epidemiological and pathophysiological aspects of ADAS, with a focus on the impact of ADAS from clinical and economic perspectives. We offer a global overview of the available evidence for treatment of ADAS and with priorities suggested for addressing current gaps in the literature and unmet clinical needs to improve outcomes for AS patients. |
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