Retrograde catheterisation vs. Doppler echocardiographic evaluation of aortic stenosis--a survey of contemporary UK practice.
Aortic stenosis (AS) is the most common indication for valve surgery. Recent data suggested an increased risk of cerebral emboli when the aortic valve is crossed to obtain 'pull-back' gradient. We conducted a large questionnaire based study to evaluate current practice in the assessment of aortic valve gradient amongst cardiologists and the preferences of cardiac surgeons in the UK. E-mail questionnaires were sent to 645 (72%) UK consultant cardiologists and to 198 (92%) UK consultant cardiac surgeons. 232 cardiologists and 52 cardiac surgeons responded. 53% of cardiologists routinely attempt to cross the valve in moderate AS while only 23% do so in severe AS. 38% of cardiologists in the age group '50+ years' cross the valve in severe AS compared to 13% in the age group '30-40 years'. Common reasons given for crossing a stenosed valve included 'to verify the echocardiographic gradient' (85%) and 'maintaining skill' (24%). 64% of cardiologists have changed their views on the necessity of crossing the valve in the last ten years. Although the majority appreciate the increased risk of crossing the valve only 18% of patients are consented differently if crossing the valve is planned. 26% of cardiac surgeons prefer the valve to be crossed to provide information on 'pull-back' gradient, 32% for LV function assessment and 14% to confirm MV competence. 92% would accept echocardiographic data alone if both the gradient and aortic valve area were available and considered correct.


CONCLUSIONS
Our survey found that the practice of crossing the aortic valve has changed in the last 10 years and that younger consultant cardiologists are less likely to cross the aortic valve. Increasing confidence in echocardiographic data and potential complications of crossing the valve are implicated. 92% of cardiac surgeons do not require the valve to be crossed if the echo data is considered accurate.
Fazal
Iftikhar A
IA
Alfakih
Khaled
K
Wilcox
Robert G
RG
Walsh
John T
JT
D000328:Adult; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization; D002309:Cardiology; D015150:Echocardiography, Doppler; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D011795:Surveys and Questionnaires; D006113:United Kingdom