From the Guidelines
Treatment options for aortic stenosis include Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR).
Treatment Options
- Surgical Aortic Valve Replacement (SAVR): indicated for symptomatic severe aortic stenosis, with a Class I, Level of Evidence: B recommendation 1
- Transcatheter Aortic Valve Replacement (TAVR): a viable alternative to SAVR, with a Class I, Level of Evidence: A recommendation for inoperable/high- and intermediate-risk cohorts, and a Class IIa, Level of Evidence: B recommendation for intermediate-risk cohorts 1
- Balloon Aortic Valvuloplasty: a reasonable option 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: not indicated for symptomatic severe aortic stenosis, but may be used to control blood pressure and other risk factors 1
Patient Selection
The selection of patients for TAVR or SAVR depends on various factors, including symptom status, left ventricular function, surgical risk, and the presence of concomitant coronary or other valve disease 1.
Current Guidelines
Current guidelines endorse TAVR as a Class I, Level of Evidence: A recommendation for inoperable/high- and intermediate-risk cohorts, and a Class IIa, Level of Evidence: B recommendation for intermediate-risk cohorts 1. However, the quantum of evidence is insufficient to support a strong recommendation for TAVR in low-risk patients 1.
From the Research
Treatment Options for Aortic Stenosis
The treatment options for aortic stenosis include:
- Aortic valve replacement, which is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography 2
- Watchful waiting, which is recommended for most asymptomatic patients 2
- Surgical valve replacement, which is the standard of care for patients at low to moderate surgical risk 2, 3
- Transcatheter aortic valve replacement, which may be considered in patients at high or prohibitive surgical risk 2, 3, 4
- Medical management of concurrent hypertension, atrial fibrillation, and coronary artery disease to lead to optimal outcomes 2
Medical Treatment
Medical treatment of aortic stenosis has been studied, with a focus on:
- Lipid-lowering therapy 5
- Antihypertensive drugs 5
- Anticalcific therapy 5 However, medical therapies for aortic stenosis remain ineffective, with surgical aortic valve replacement remaining the only proven effective long-term treatment 5, 3
Quality of Life
Aortic stenosis may have an important impact on patients' quality of life, and transcatheter aortic valve implantation (TAVI) can provide a significant survival benefit 6 The assessment of quality of life in patients with aortic stenosis is important, and there are various tools available to measure it 6 Frailty and comorbidities may limit the beneficial effect of aortic stenosis interventions in terms of quality of life, and current guidelines mention the importance of avoiding the futility of interventions 6