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**41**

*Aortic Valve Disease: State of the Art*

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Babaliaros V, Kodali SK, Rajeswaran J,

transcatheter aortic valve replacement in the PARTNER-I trial. Annals of Thoracic Surgery. 2015;**100**:785-792

Gentile M, Aruta P, et al. Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis. The American Journal of

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*DOI: http://dx.doi.org/10.5772/intechopen.93311*

*Aortic Valve Disease: State of the Art DOI: http://dx.doi.org/10.5772/intechopen.93311*

*Advances in Complex Valvular Disease*

2018;**93**:488-508

2003;**108**:319-324

2017;**70**:2752-2763

2019;**31**:771-772

2019;**73**:1741-1752

valve stenosis. Mayo Clinic Proceedings.

with aortic incompetence and aneurysm of the ascending aorta. The Journal of Thoracic and Cardiovascular Surgery.

[65] Milewicz DM, Regalado ES, Guo DC. Treatment guidelines for thoracic aortic aneurysms and dissections based on the underlying causative gene. The Journal of Thoracic and Cardiovascular Surgery.

[66] Cooper MA, Upchurch GR Jr. The society of vascular surgery practice guidelines on the care of patients with abdominal aortic aneurysms. JAMA

Surgery. 2019;**154**:553-554

[67] Scherman J, Weich H. SASCI/ SCTSSA joint consensus statement and guidelines on transcatheter aortic valve implantation (TAVI) in South Africa. Cardiovascular Journal of Africa.

[68] Lung B. Aortic stenosis in the elderly: Surgery or TAVI. New

[69] Pighi M, Serdoz R, Kilic ID, Sherif SA, Lindsay A, Di Mario C. TAVI: New trials and registries offer further welcome evidence—U.S.

European guidelines. Presse Médicale.

CoreValve, CHOICE, and GARY. Global Cardiology Science and Practice.

[70] Giordana F, Bruno F, Conrotto F, Saglietto A, D'Ascenzo F, Marra WG, et al. Incidence, predictors and outcomes of valve-in-valve TAVI: A systematic review and meta-analysis. International Journal of Cardiology.

1992;**103**:617-621

2010;**140**:S2-S4

2016;**27**:399-400

2013;**42**:986-994

2014;**2014**:78-87

2020;**316**(2020):64-69

2020;**35**(7):1395-1748

[71] Ram E, Amunts S, Zuroff E, Peled Y, Kogan A, Raanani E, et al. Outcomes of isolated surgical aortic valve replacement in the era of

transcatheter aortic valve implantation. Journal of Cardiac Surgery. 20 July

[58] Harris AW, Pibarot P, Otto CM. Aortic stenosis: Guidelines and evidence gaps. Cardiology Clinics. 2020;**38**:55-63

[59] Malik AH, Zaid S, Ahmad H, Goldberg J, Dutta T, Undemir C, et al. A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis. Journal of Geriatric Cardiology. 2020;**17**:43-50

[60] Monin JL, Quere JP, Monchi M, Petit H, Baleynaud S, Chauvel C, et al. Low-gradient aortic stenosis: Operative risk stratification and predictors for long-term outcome: A multicenter study using dobutamine stress hemodynamics. Circulation.

[61] Yoon SH, Schmidt T, Bleiziffer S, Schofer N, Fiorina C, Munoz-Garcia AJ,

[62] Bando K. Filling the gap between guidelines and current surgical practice: Is early surgery justified in patients with asymptomatic severe aortic regurgitation with normal left ventricular function? Seminars in Thoracic and Cardiovascular Surgery.

[63] Yang LT, Michelena HI, Scott CG, Enriquez-Sarano M, Pislaru SV, Schaff HV, et al. Outcomes in chronic hemodynamically significant aortic regurgitation and limitations of current guidelines. Journal of the American College of Cardiology.

[64] David TE, Feindel CM. An aortic valve-sparing operation for patients

et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. Journal of the American College of Cardiology.

**40**

[72] Mazine A, El-Hamamsy I. Procedures and outcomes of surgical aortic valve replacement in adults. Cardiology Clinics. 2020;**38**:89-102

[73] Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. 5-Year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet. 2015;**385**:2477-2484

[74] Tang GH, Lansman SL, Panza JA. Beyond PARTNER: Appraising the evolving trends and outcomes in transcatheter aortic valve replacement. Cardiology in Review. 2015;**23**:1-10

[75] Thourani VH, Jensen HA, Babaliaros V, Kodali SK, Rajeswaran J, Ehrlinger J, et al. Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER-I trial. Annals of Thoracic Surgery. 2015;**100**:785-792

[76] Tamburino C, Barbanti M, Capodanno D, Mignosa C, Gentile M, Aruta P, et al. Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis. The American Journal of Cardiology. 2012;**109**:1487-1493

**43**

**Chapter 3**

Disease

**Abstract**

valve disease.

**1. Introduction**

intervention, global longitudinal strain

Clinical Applications of

*Ernesto E. Salcedo and Edward A. Gill*

Strain Imaging in Aortic Valve

The prevalence of aortic valve disease, particularly aortic stenosis, is increasing in parallel to the aging of the population, making it the most prevalent form of valvular heart disease. Surgery and percutaneous interventions of the aortic valve are conditional to a comprehensive evaluation of the aortic valve and the left ventricle (LV). Favorable results from aortic valve surgery or intervention are influenced by LV ejection fraction (EF), presence and severity of left ventricular hypertrophy (LVH), LV end-systolic volume (LVESV), degree of leaflet calcification, and trans-aortic valve gradients. Deformation imaging, particularly global longitudinal strain, is evolving as a powerful tool in the evaluation of ventricular function in patients with aortic stenosis. GLS is particularly suited to detect subclinical LV dysfunction, before a drop in LV ejection fraction, providing the opportunity to intervene earlier to prevent serious and permanent LV dysfunction. Similar added value has been demonstrated in the application of GLS in the detection of subclinical LV dysfunction in patients with aortic regurgitation. Very little information exists in the use of GLS in patients with mixed aortic valve disease, providing an opportunity for future research in this important group of patients with aortic

**Keywords:** aortic stenosis, aortic regurgitation, aortic valve surgery, aortic valve

As the population grows older, the prevalence of aortic valve disease, particularly aortic stenosis, is swelling, making it currently, the most prevalent form of valvular heart disease [1–3]. Surgery and percutaneous interventions of the aortic valve are frequently needed in patients with severe symptomatic aortic valve disease, the timing for these procedures' conditional on a comprehensive evaluation of the dysfunctional aortic valve and the resultant repercussions on the rest of the heart, particularly the left ventricle (LV). Parameters used to predict favorable/unfavorable results from aortic valve surgery or intervention include LV ejection fraction (EF), presence and severity of left ventricular hypertrophy
