From the Guidelines
Aortic valve stenosis treatment should prioritize surgical aortic valve replacement (SAVR) for symptomatic severe aortic stenosis, while transcatheter aortic valve replacement (TAVR) is recommended for patients with severe, symptomatic, calcific stenosis who have a prohibitive surgical risk, as indicated by the 2017 ACC expert consensus decision pathway 1.
Symptoms of Aortic Valve Stenosis
The symptoms of aortic valve stenosis include:
- Shortness of breath
- Chest pain
- Dizziness
- Fainting These symptoms occur due to the narrowing of the aortic valve, which restricts blood flow from the heart to the body, leading to increased cardiac workload and potentially heart failure if left untreated.
Treatment Options
Treatment options for aortic valve stenosis depend on the severity of the condition and may include:
- Surgical Aortic Valve Replacement (SAVR): recommended for symptomatic severe aortic stenosis, as well as for patients undergoing coronary artery bypass grafting (CABG), aortic surgery, or other valve surgery 1.
- Transcatheter Aortic Valve Replacement (TAVR): a reasonable alternative to SAVR for patients at high surgical risk, as defined by an estimated 50% or greater risk of mortality or irreversible morbidity at 30 days 1.
- Balloon Aortic Valvuloplasty: may be considered for palliation in adult patients with aortic stenosis who cannot undergo surgical AVR due to serious comorbid conditions, or as a bridge to surgical AVR 1.
- Medical Therapy: no specific therapy is recommended for asymptomatic aortic stenosis, while medical therapy is not indicated for symptomatic severe aortic stenosis; however, control of blood pressure and other risk factors, as well as symptom management, may be necessary 1.
Management and Follow-up
Regular follow-up with a cardiologist is essential for proper management of aortic valve stenosis. Patients should monitor for worsening symptoms and undergo periodic echocardiograms to assess the severity of the condition. The 2017 ACC expert consensus decision pathway recommends individualized treatment decisions using clinical and imaging evaluation, risk category, patient goals and expectations, and futility considerations 1.
From the Research
Symptoms of Aortic Valve Stenosis
- Symptoms of aortic valve stenosis include chest pain, fainting, and shortness of breath 2
- Asymptomatic patients with severe aortic valve stenosis are at risk for adverse events, including sudden cardiac death 3
- Clinical and echocardiographic characteristics can guide treatment decisions for asymptomatic patients 3
Treatment Options for Aortic Valve Stenosis
- Surgical aortic valve replacement (SAVR) is a Class Ia recommended therapy for specific subgroups of severe aortic stenosis patients 4
- Transcatheter aortic valve implantation (TAVI) is also a Class Ia recommended therapy for specific subgroups of severe aortic stenosis patients 4
- TAVI has become the preferred treatment option in appropriate patients with symptomatic severe aortic stenosis 5
- SAVR is associated with significantly lower all-cause mortality and heart failure hospitalization compared to conservative treatment in asymptomatic severe aortic stenosis patients 6
- Transcatheter aortic valve replacement (TAVR) has expanded the eligible population to include bicuspid aortic valve with feasible anatomy, small aortic annuli, low-flow, low-gradient AS, and younger patients 5
Treatment Guidelines
- Current guidelines suggest aortic valve replacement in the presence of specific characteristics, including left ventricular dysfunction and very severe AS with significantly elevated gradients 3
- A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualized management decisions 4
- Randomized trials are needed to establish a clear benefit of SAVR in asymptomatic severe aortic stenosis patients 6