From the Guidelines
Lambl's excrescences are not directly related to Cerebrovascular Accident (CVA) or Aortic Valve Replacement (AVR), but patients with aortic stenosis who undergo AVR, including TAVR, may be at risk for CVA as a procedural complication. The relationship between Lambl's excrescences, CVA, and AVR is not well-established in the provided evidence. However, it is known that Lambl's excrescences are small, benign growths that can be found on the aortic valve, and they are not typically associated with an increased risk of CVA or AVR.
In terms of CVA and AVR, the evidence suggests that patients with severe aortic stenosis who undergo TAVR may be at risk for CVA as a procedural complication 1. The risk of CVA is higher with TAVR than with standard therapy, particularly in the first 30 days after the procedure. However, TAVR has been shown to be effective in reducing the risk of death and improving symptoms in patients with severe aortic stenosis who are at high risk for surgical AVR.
The management of patients with severe aortic stenosis who are at risk for CVA includes careful consideration of the risks and benefits of TAVR versus surgical AVR. The decision to proceed with TAVR or surgical AVR should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history. Patients who undergo TAVR should be closely monitored for signs of CVA, and prompt treatment should be initiated if a CVA occurs.
Some key points to consider in the management of patients with severe aortic stenosis who are at risk for CVA include:
- The risk of CVA is higher with TAVR than with standard therapy, particularly in the first 30 days after the procedure 1
- TAVR has been shown to be effective in reducing the risk of death and improving symptoms in patients with severe aortic stenosis who are at high risk for surgical AVR 1
- The decision to proceed with TAVR or surgical AVR should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history
- Patients who undergo TAVR should be closely monitored for signs of CVA, and prompt treatment should be initiated if a CVA occurs 1
From the Research
Relationship Between Lambl's Excrescences, CVA, and AVR
- Lambl's excrescences are associated with an increased risk of cerebrovascular accident (CVA) due to embolization 2, 3, 4.
- The presence of Lambl's excrescences on the aortic valve can lead to cerebral embolism, and patients with a history of CVA may benefit from surgical excision of the excrescences 2, 3.
- Transesophageal echocardiography (TEE) is the gold standard for diagnosing Lambl's excrescences 2, 3, 4, 5.
- Patients with asymptomatic Lambl's excrescences can be monitored closely, while those with a history of CVA may require anticoagulation or surgical treatment 2, 3, 4, 5.
- Aortic valve replacement (AVR) may be necessary in some cases, particularly if the patient has underlying valve disease or requires open-heart surgery for other reasons 6.
Management of Lambl's Excrescences
- There is no established guideline for the management of Lambl's excrescences, but treatment options include anticoagulation, antiplatelet therapy, and surgical excision 2, 3, 4, 5.
- Patients with recurrent ischemic events may benefit from anticoagulation and discussion about surgical excision 4.
- Aspirin is a commonly used treatment option for patients with Lambl's excrescences and a history of embolic events 5.