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Heart failure and excess mortality after aortic valve replacement in aortic stenosis

Aziminia, Nikoo; Nitsche, Christian; Mravljak, Rok; Bennett, Jonathan; Thornton, George D; Treibel, Thomas A; (2023) Heart failure and excess mortality after aortic valve replacement in aortic stenosis. Expert Review of Cardiovascular Therapy , 21 (3) pp. 193-210. 10.1080/14779072.2023.2186853. Green open access

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Abstract

INTRODUCTION: In aortic stenosis (AS), the heart transitions from adaptive compensation to an AS cardiomyopathy and eventually leads to decompensation with heart failure. Better understanding of the underpinning pathophysiological mechanisms is required in order to inform strategies to prevent decompensation. AREAS COVERED: In this review, we therefore aim to appraise the current pathophysiological understanding of adaptive and maladaptive processes in AS, appraise potential avenues of adjunctive therapy before or after AVR and highlight areas of further research in the management of heart failure post AVR. EXPERT OPINION: Tailored strategies for the timing of intervention accounting for individual patient's response to the afterload insult are underway, and promise to guide better management in the future. Further clinical trials of adjunctive pharmacological and device therapy to either cardioprotect prior to intervention or promote reverse remodelling and recovery after intervention are needed to mitigate the risk of heart failure and excess mortality.

Type: Article
Title: Heart failure and excess mortality after aortic valve replacement in aortic stenosis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/14779072.2023.2186853
Publisher version: https://doi.org/10.1080/14779072.2023.2186853
Language: English
Additional information: Copyright © 2023 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Aortic stenosis, aortic valve replacement, heart failure, left ventricular hypertrophy, myocardial fibrosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10166211
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