Management of bicuspid aortic disease in the TAVI era
Nov 5, 2024
auto_awesome
Join Professor Marjan Jahangiri, a leading cardiac surgeon at St George's Hospital, as he unpacks the complexities of managing bicuspid aortic valve disease. He explores the role of Transcatheter Aortic Valve Implantation (TAVI) in treatment, discussing its risks and personalized care approaches. Delve into the genetic factors, clinical features, and post-operative monitoring necessary for optimal outcomes. Jahangiri also shares insights on future advancements and the importance of research in enhancing patient care.
Bicuspid aortic valve disease requires careful monitoring and tailored surgical intervention due to its unique risks and complications.
The role of TAVI for bicuspid aortic valves remains uncertain, with current guidelines favoring traditional surgery for most patients.
Deep dives
Understanding Bicuspid Aortic Valve Disease
Bicuspid aortic valve disease, a common congenital heart abnormality, affects up to 2% of the population and is associated with significant health risks. Patients typically develop aortic stenosis or regurgitation much earlier than those with tricuspid aortic valves, often presenting symptoms in their 50s, but some can present as early as their 20s. The disease can lead to serious complications, including aortic aneurysms, primarily affecting the aortic root and ascending aorta. Asymptomatic patients and those with mild valve issues may require careful monitoring, particularly if they also have an enlarged aorta.
Guidelines and Surgical Interventions
Current guidelines recommend surgical intervention for patients with symptomatic or asymptomatic aortic stenosis and regurgitation, similar to those with tricuspid valves. However, particular attention is given to patients with bicuspid valves and aortic aneurysms, necessitating intervention when the ascending aorta reaches a diameter of 4.5 centimeters or more. The decision-making process involves balancing the patient’s valve condition with the size of the aorta and risks associated with surgery. Discussions between surgeons and patients play a crucial role, as each case requires tailored management considering the complexities involved.
The Role of TAVI in Bicuspid Aortic Valve Management
Transcatheter aortic valve implantation (TAVI) has revolutionized treatment for aortic valve disease, but its application for patients with bicuspid aortic valves remains controversial and is not yet well-established. Early trials that included patients with bicuspid valves indicated higher risks for complications like pacemaker requirements and paravalvular leaks compared to tricuspid patients. While TAVI may benefit some high-risk elderly patients, particularly those without significant aortic root issues, surgical interventions are generally preferred for the broader population. Looking ahead, advancements in technology may improve outcomes and expand TAVI's applicability, yet thorough trial data is still needed to guide future practices.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by cardiac surgeon Professor Marjan Jahangiri from St George's Hospital, London. They discuss how to manage this condition and how and why TAVI might be used. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.