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Billig S, Hein M, Uhlig M, Schumacher D, Thudium M, Coburn M, Weisheit CK. [Anesthesia for aortic valve stenosis : Anesthesiological management of patients with aortic valve stenosis during noncardiac surgery]. DIE ANAESTHESIOLOGIE 2024; 73:168-176. [PMID: 38334810 PMCID: PMC10920418 DOI: 10.1007/s00101-024-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Aortic valve stenosis is a common condition that requires an anesthesiologist's in-depth knowledge of the pathophysiology, diagnostics and perioperative features of the disease. A newly diagnosed aortic valve stenosis is often initially identified from the anamnesis (dyspnea, syncope, angina pectoris) or a suspicious auscultation finding during the anesthesiologist's preoperative assessment. Interdisciplinary collaboration is essential to ensure the optimal management of these patients in the perioperative setting. An accurate anamnesis and examination during the preoperative assessment are crucial to select the most suitable anesthetic approach. Additionally, a precise understanding of the hemodynamic peculiarities associated with aortic valve stenosis is necessary. After a short summary of the overall pathophysiology of aortic valve stenosis, this review article focuses on the specific anesthetic considerations, risk factors for complications, and the perioperative management for noncardiac surgery in patients with aortic valve stenosis.
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Affiliation(s)
- Sebastian Billig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Marc Hein
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Moritz Uhlig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - David Schumacher
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Marcus Thudium
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Mark Coburn
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christina K Weisheit
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Wiens EJ, Kawa K, Kass M, Shah AH. Impact of biological sex on valvular heart disease, interventions, and outcomes. Can J Physiol Pharmacol 2024. [PMID: 38427984 DOI: 10.1139/cjpp-2023-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Valvular heart disease (VHD) is common, affecting >14% of individuals aged >75, and is associated with morbidity, including heart failure and arrhythmia, and risk of early mortality. Increasingly, important sex differences are being found between males and females with VHD. These sex differences can involve the epidemiology, pathophysiology, presentation, diagnosis, and outcomes of the disease. Females are often disadvantaged, and female sex has been shown to be associated with delayed diagnosis and inferior outcomes in various forms of VHD. In addition, the unique pathophysiologic state of pregnancy is associated with increased risk for maternal and fetal morbidity and mortality in many forms of VHD. Therefore, understanding and recognizing these sex differences, and familiarity with the attendant risks of pregnancy and management of pregnant females with VHD, is of great importance for any primary care or cardiovascular medicine practitioner caring for the female patient. This review will outline sex differences in aortic, mitral, pulmonic, and tricuspid VHD, with particular focus on differences in pathophysiology, clinical presentation, and outcomes. In addition, the pathophysiology and management implications of pregnancy will be discussed.
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Affiliation(s)
- Evan J Wiens
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kristal Kawa
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Malek Kass
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ashish H Shah
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Irtyuga O, Babakekhyan M, Kostareva A, Uspensky V, Gordeev M, Faggian G, Malashicheva A, Metsker O, Shlyakhto E, Kopanitsa G. Analysis of Prevalence and Clinical Features of Aortic Stenosis in Patients with and without Bicuspid Aortic Valve Using Machine Learning Methods. J Pers Med 2023; 13:1588. [PMID: 38003903 PMCID: PMC10671965 DOI: 10.3390/jpm13111588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Aortic stenosis (AS) is the most commonly diagnosed valvular heart disease, and its prevalence increases with the aging of the general population. However, AS is often diagnosed at a severe stage, necessitating surgical treatment, due to its long asymptomatic period. The objective of this study was to analyze the frequency of AS in a population of cardiovascular patients using echocardiography (ECHO) and to identify clinical factors and features associated with these patient groups. We utilized machine learning methods to analyze 84,851 echocardiograms performed between 2010 and 2018 at the National Medical Research Center named after V.A. Almazov. The primary indications for ECHO were coronary artery disease (CAD) and hypertension (HP), accounting for 33.5% and 14.2% of the cases, respectively. The frequency of AS was found to be 13.26% among the patients (n = 11,252). Within our study, 1544 patients had a bicuspid aortic valve (BAV), while 83,316 patients had a tricuspid aortic valve (TAV). BAV patients were observed to be younger compared to TAV patients. AS was more prevalent in the BAV group (59%) compared to the TAV group (12%), with a p-value of <0.0001. By employing a machine learning algorithm, we randomly identified significant features present in AS patients, including age, hypertension (HP), aortic regurgitation (AR), ascending aortic dilatation (AscAD), and BAV. These findings could serve as additional indications for earlier observation and more frequent ECHO in specific patient groups for the earlier detection of developing AS.
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Affiliation(s)
- Olga Irtyuga
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Mary Babakekhyan
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Anna Kostareva
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Vladimir Uspensky
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Michail Gordeev
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Giuseppe Faggian
- Department of Cardiac Surgery, University of Verona Medical School, 37134 Verona, Italy;
| | - Anna Malashicheva
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Oleg Metsker
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Evgeny Shlyakhto
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
| | - Georgy Kopanitsa
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia; (O.I.); (M.B.); (A.K.); (V.U.); (M.G.); (A.M.); (O.M.); (E.S.)
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Pevnick JM, Diniz MA, Magoffin D, Ishimori M, Bairey Merz CN. Microvascular Aging and Eicosanoids-Women's Evaluation of Systemic Aging Tenacity ("You are never too old to become younger!") Specialized Center of Research Excellence on Sex Differences Career Enhancement Core: Building the Future. J Womens Health (Larchmt) 2023; 32:883-890. [PMID: 37585514 PMCID: PMC10623456 DOI: 10.1089/jwh.2022.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
The objective of the National Institutes of Health Office of Research in Women's Health (NIH/ORWH) Specialized Center of Research and Career Enhancement (SCORE) program is to expedite the development and application of new knowledge that affect women, to learn more about the etiology of these diseases, and to foster improved approaches to treatment and/or prevention. Each SCORE has a Career Enhancement Core (CEC) that serves to meet the career enhancement needs of translational science in the study of sex differences. The Microvascular Aging and Eicosanoids-Women's Evaluation of Systemic aging Tenacity (MAE-WEST) ("You are never too old to become younger!") Specialized Center of Research Excellence (SCORE) on Sex Differences will study pro- and anti-inflammatory responses and small vessel aging traits. As part of our SCORE CEC, we have advanced several initiatives to embed consideration of sex as a biological variable (SABV) into the infrastructure of our two CEC institutions. Unlike other professions, ongoing physician education through continuing medical education (CME) activities is required and embedded in the practice of medicine. The MAE-WEST SCORE in collaboration with the CSMC Clinical Scholars Program, the Center for Research in Women's Health and Sex-differences and the CSMC CME Office requires SABV and as Diversity, Equity, and Inclusion components in all CSMC CME programs. Clinical practice is also increasingly guided by evidence-based guidelines, with Class I recommendations resulting from clinical trials rather than expert consensus. It is essential that women be included in clinical trials proportionate to the prevalence and burden of disease. The MAE-WEST SCORE has developed our own unique CEC for providing novel educational, networking, funding opportunities, and translation to practice support. The developed best practices have found novel ways to enhance studies of women's health and SABV. We welcome visitors on-site and virtual to share with the broader academic and practicing community.
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Affiliation(s)
- Joshua M. Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marcio A. Diniz
- Biostatistics Research Center, Samuel Oschin Comprehensive Cancer Institute, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Biomedical Science, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Denis Magoffin
- Department of Biomedical Science, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko Ishimori
- Division of Rheumatology, Department of Medicine, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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