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Medical and Surgical Management of Aortic Valve Disease

Join Dr. Joseph E. Bavaria, MD and the team of University of Pennsylvania cardiology and surgery specialists in reviewing of all the important topics related to aortic valve conditions that a cardiovascular clinician faces on a daily basis.

Source: University of Pennsylvania School of Medicine [more]

This educational activity represents a review of all the important topics related to aortic valve conditions that a cardiovascular clinician faces on a daily basis. Topics covered include the natural history of aortic valvular disease and the clinical decision making process required to ensure appropriate referral for surgical correction with aortic valve replacement. The pros and cons of mechanical valve vs tissue valve are examined in detail to help guide both clinicians and patients with this important decision. Distinction is made between the physiology, and the eventual pathology, of aortic valve insufficiency and aortic valve stenosis. Recent, more advanced concepts in human aortic valve anatomy suggest that the "aortic valve" is the "aortic root", as the two concepts are virtually indistinguishable. A presentation of the latest concepts regarding aortic valve replacement and aortic root reconstruction is included. Data and commentary are presented to help differentiate between mechanical and tissue valve results, and to attempt to distinguish between the clinical outcomes within both tissue aortic valve replacement and tissue aortic root reconstructive options. The overall guiding philosophy of this educational activity is to relate valvular physiology and anatomy to disease natural history and definitive surgical correction, as a continuous clinical thought process.

There is no commercial support associated with this activity.

This educational activity is designed for cardiologists, internists, and other health care professionals involved with the referral and/or management of patients with valvular and structural heart disease.

After completing this educational activity, participants should be better able to:

• Describe the natural history of aortic stenosis
• Discuss the current medical treatments of aortic stenosis and their efficacy
• Review and understand the 2006 ACC/AHA guidelines for aortic valve replacement in aortic stenosis
• Understand the etiology and pathophysiology of aortic regurgitation and the underlying ventricular changes that occur
• Review the currently-available imaging techniques to quantitate aortic regurgitation severity and evaluate underlying ventricular size and function
• Highlight the asymptomatic nature of aortic regurgitation, and the importance of detecting subclinical cardiovascular dysfunction
• Understand the current ACC/AHA guidelines for surgical intervention in aortic regurgitation
• Discuss the pros and cons of tissue and mechanical prosthesis
• Discuss the current guidelines and recommendations regarding choice of prosthesis
• Review the 2006 ACC/AHA guidelines for recommendation of aortic valve prosthesis
• Describe the surgical anatomy and aortic root geometric relationships important for successful aortic root reconstruction and echocardiographic analysis. This includes the critical importance of annular, sinus segment and sino-tubular junction optimization
• Review all the available implant options used during aortic root reconstruction. This includes an analysis and data review of mechanical composite grafts, porcine bio-roots, homografts, and more complex aortic valve sparing root procedures
• Differentiate between the latest procedures, concepts, and techniques used in aortic valve sparing reimplantation aortic root reconstruction. This includes an overview of the indications for these procedures especially in relation to aortic root replacement options available to clinicians
• Address the significance of bicuspid aortic valve syndrome, both as an aortic valve disease and an abnormal proximal aortic condition

You must sign-up for an account. If you do not have an account please sign-up now (click on member sign-up at the top of the page). If you have an account make sure you are logged in to the CME Portal with your e-mail address and password (click on log in). You must then register for the activity by using the link in the "Course Materials" box on the right. Once you are registered for the activity, you will be able to click on the BEGIN THE ACTIVITY link in the "Course Materials" box. At the conclusion of the activity, click on "Get CME " and an evaluation will be available to you. Upon completing the evaluation, you will be able to view and print a CME certificate verifying your credit for this activity.

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Jonathan Gomberg, MD, FACC
Clinical Assistant Professor
Department of Medicine
Division of Cardiovascular Medicine
University of Pennsylvania School of Medicine
University of Pennsylvania Health System
Philadelphia, PA

Martin G. Keane, MD, FACC, FAHA
Associate Professor of Medicine
Department of Medicine
Division of Cardiovascular Medicine
University of Pennsylvania School of Medicine
University of Pennsylvania Health System
Philadelphia, PA

Wilson Y. Szeto, MD
Assistant Professor of Surgery
Division of Cardiovascular Surgery
University of Pennsylvania Health System
Philadelphia, PA

Joseph E. Bavaria, MD
Roberts-Measey Professor of Surgery and Vice Chief of Cardiovascular Surgery
University of Pennsylvania School of Medicine
Director, Thoracic Aortic Surgery Program
Division of Cardiovascular Surgery
University of Pennsylvania Health System
Philadelphia, PA

The University of Pennsylvania School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Pennsylvania School of Medicine designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is policy at the University of Pennsylvania School of Medicine for individuals who are in a position to control the content of an educational activity to disclose to the learners all relevant financial relationships that they have with any commercial interest(s) that provide products or services that may be relevant to the content of this continuing medical education activity.

The following faculty have disclosed that they have no relevant financial relationships with any commercial interests related to the content of this educational activity:

Jonathan Gomberg, MD, FACC
Martin G. Keane, MD, FACC, FAHA
Wilson Y. Szeto, MD

The following faculty have reported the following relevant financial relationships with commercial interests related to the content of this educational activity:

Dr. Bavaria has received research support from Edwards and St. Jude and he has served as a member of the speakers’ bureau for Vascutek.

Staff of the University of Pennsylvania School of Medicine Office of CME have reported no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

The University of Pennsylvania School of Medicine requires all faculty to disclose any discussion of an investigational and/or off-label use of a pharmaceutical product or device within their presentation. Participants should note that the use of products outside FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for approved indications.

Please note the following detailed list of off-label and/or investigational use of products within this educational activity:

Nitroprusside - treatment of CHF in presence of severe AS
Dobutamine - increase cardiac output for diagnostic/prognostic testing in AS