Author + information
- Received September 6, 2017
- Revision received October 16, 2017
- Accepted October 17, 2017
- Published online December 11, 2017.
- Johannes Steiner, MDa,b,
- Josep Rodés-Cabau, MDc,
- David R. Holmes Jr., MDd,
- Martin M. LeWinter, MDa and
- Harold L. Dauerman, MDa,∗ ()
- aDivision of Cardiology and Cardiovascular Research Institute, University of Vermont Medical Center, Burlington, Vermont
- bDivision of Cardiovascular Medicine, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cQuebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
- dDepartment of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Harold L. Dauerman, Division of Cardiology, University of Vermont Medical Center, 111 Colchester Avenue, McClure 1, Burlington, Vermont 05401.
The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
Dr. Rodés-Cabau has received a research grant from Edwards Lifesciences and Medtronic. Dr. Dauerman has received a research grant from Medtronic, Edwards, and Boston Scientific; and is a consultant for Medtronic, Edwards, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Michael J. Mack, MD, served as Guest Editor for this paper.
- Received September 6, 2017.
- Revision received October 16, 2017.
- Accepted October 17, 2017.
- 2017 American College of Cardiology Foundation
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