Tailoring Of Treatment in Aortic Valve Intervention – TOTAVI

Tidsperiod:

1 januari – 31 december 2022

Projektledare:

Stefan James

Projektdeltagare:

Karl-Henrik Grinnemo, Christina Christersson

Finansiär:

Hjärt-Lungfonden

Bidragstyp:

Projektbidrag

Budget:

600 000 SEK

Bakgrund:

Aortic stenosis (AS) is a degenerative disease with largely unknown mechanisms with a very high prevalence. It is often associated with considerable symptoms, poor quality of life and a poor prognosis. The only treatment is valve replacement, but the optimal time is unknown and operations involve risks. When the disease is detected there is a high risk of permanent heart failure due to pressure overload of the left ventricle leading to hypertrophy and fibrosis with reduced diastolic or systolic function, and impaired right ventricular function

Målsättning:

To make a broad effort to increase our understanding of the mechanisms for the origin and development of aortic stenosis, to seek possiblities for medical treatment, to be able to detect the disease earlier and optimize the time point for surgery, to reduce risks during and after surgery, to identify risk factors for the continuous deterioration of heart function and improve quality of life.

Arbetsplan:

Several observational studies are ongoing using large retrospective databases for a deeper understanding of the course of the disease and identifying hypothesis generating associations.

A retrospective imaging patient cohort of pre-operative echocardiography and CT images of all patients who have undergone TAVI in Uppsala have been collected (n=600) and will be re analysed for left and right heart function and myocardial structure and linked to biomarker analyses which are stored in an existing biobank

A large prospective data base of patients with severe AS accepted for TAVI or SAVR is being collected for extended investigation of imaging (echo, MRI and PEF), biomarker profiling and patient´s performance.

We are analyzing explanted aortic valves from patients with bicuspid and tricuspid valves with regard to extracellular matrix content and its interaction with cells. We will analyze the blood and, particularly, extracellular vesicles from the blood of the patients with bicuspid for protein and miRNA markers.

Finally, we are planning a prospective registry based randomized trials to evaluate anti thrombotic therapy post aortic valve intervention, differential treatment of bicuspid and tricuspid valves and evaluate potent lipid-lowering therapies on the progression of AS

Betydelse:

Our project has the potential to lead to earlier detection, individualized treatment including medical and surgical treatment at the right time, avoid heart failure and give patients better and longer lifes.