From the Guidelines
Aortic stenosis patients with severe symptomatic stenosis should undergo valve replacement, either through surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), as determined by factors such as symptom status, left ventricular function, surgical risk, and the presence of concomitant coronary or other valve disease 1. The treatment of aortic stenosis depends on the severity of the condition, with mild cases requiring regular monitoring and severe symptomatic stenosis necessitating valve replacement.
Key Considerations
- The most common cause of aortic stenosis is age-related calcification, but it can also result from congenital abnormalities or rheumatic heart disease.
- Symptoms typically develop gradually and include chest pain, shortness of breath, fatigue, dizziness, and fainting, especially during physical activity.
- Diagnosis involves physical examination, echocardiography, electrocardiogram, and sometimes cardiac catheterization.
- Medical therapy alone cannot reverse the valve narrowing but may help manage symptoms through blood pressure control and fluid balance.
- Regular cardiology follow-up is essential, with echocardiograms typically performed every 6-12 months for moderate stenosis and more frequently for severe cases.
Treatment Options
- SAVR or TAVR is appropriate in most patients with symptomatic AS at intermediate or high surgical risk 1.
- TAVR has been demonstrated to be a viable alternative to SAVR irrespective of surgical risk 1.
- The choice between SAVR and TAVR should be individualized based on patient characteristics and preferences.
Monitoring and Follow-up
- Patients should promptly report worsening symptoms, as they indicate disease progression requiring intervention to prevent heart failure and sudden cardiac death.
- Regular monitoring and follow-up are crucial to ensure optimal management of aortic stenosis and to prevent complications.
From the Research
Aortic Stenosis Overview
- Aortic stenosis is a condition where the aortic valve narrows, affecting blood flow from the heart to the rest of the body 2.
- It affects 3% of persons older than 65 years, and survival in asymptomatic patients is comparable to that in age- and sex-matched control patients 2.
Diagnosis and Treatment
- Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography 2.
- Watchful waiting is recommended for most asymptomatic patients, but select patients may also benefit from aortic valve replacement before the onset of symptoms 2.
- Surgical valve replacement is the standard of care for patients at low to moderate surgical risk, while transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk 2.
Asymptomatic Severe Aortic Stenosis
- The long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively, and might be substantially improved by an initial AVR strategy 3.
- Aortic valve replacement significantly reduces the risk of hospitalization for heart failure in asymptomatic patients with severe AS, with comparable risks in terms of all-cause mortality, myocardial infarction, stroke, and thromboembolic events compared with conservative management 4.
- Early surgical intervention compared with a conservative watchful waiting strategy was associated with a lower heart failure hospitalization and a similar rate of stroke or myocardial infarction in asymptomatic patients with severe AS 5.
Comparison of Treatment Strategies
- Early intervention was associated with a significantly reduced risk of cardiac, non-cardiac, all-cause mortality, heart failure hospitalization, sudden cardiac death, and MACE compared with conservative management in asymptomatic patients with severe AS 6.
- There was no significant difference in the 30-day mortality, myocardial infarction, and 90-day mortality between the early intervention and conservative management groups 6.