From the Guidelines
Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) are the primary medical treatment options for aortic stenosis.
Treatment Options
- Surgical Aortic Valve Replacement (SAVR): indicated for symptomatic severe aortic stenosis, severe aortic stenosis undergoing coronary artery bypass grafting (CABG), aortic surgery, or other valve surgery, and asymptomatic severe aortic stenosis with a hypotensive response to exercise or extremely severe aortic stenosis 1.
- Transcatheter Aortic Valve Replacement (TAVR): recommended for patients with severe, symptomatic, calcific stenosis of a trileaflet aortic valve who have aortic and vascular anatomy suitable for TAVR, predicted survival of 12 months, and prohibitive surgical risk or high surgical risk 1.
- Balloon Aortic Valvuloplasty: reasonable for palliation in adult patients with aortic stenosis who cannot undergo surgical aortic valve replacement due to serious comorbid conditions or as a bridge to surgical aortic valve replacement 1.
- Medical Therapy: no specific therapy is indicated for asymptomatic aortic stenosis, and medical therapy is not recommended for symptomatic severe aortic stenosis; however, control of blood pressure and other risk factors is essential, and statins are not indicated for preventing progression of aortic stenosis 1.
Key Considerations
- The choice between SAVR and TAVR depends on the patient's surgical risk, with TAVR being a viable alternative to SAVR regardless of surgical risk 1.
- Intervention is considered appropriate for patients with severe aortic stenosis, regardless of surgical risk, especially in the presence of factors predictive of symptom onset or rapid progression 1.
- Medical management may be considered in patients with severe aortic stenosis who are not candidates for intervention or have a low surgical risk, but it is generally not recommended for symptomatic severe aortic stenosis 1.
From the Research
Medical Treatment Options for Aortic Stenosis
The medical treatment options for aortic stenosis are limited, with surgical aortic valve replacement (AVR) remaining the only proven effective long-term treatment 2, 3.
- Surgical aortic valve replacement (AVR) is the primary treatment for severe aortic stenosis, providing a significant survival benefit 2, 3, 4.
- Transcatheter aortic valve implantation (TAVI) is a well-established treatment option for symptomatic patients with severe aortic stenosis, especially for those who are inoperable or at high risk for surgical AVR 2, 5.
- Medical therapies, such as lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy, have been studied, but their effectiveness in halting the progression of aortic stenosis is still uncertain 6.
Treatment Goals and Considerations
The primary goal of treatment is to relieve the symptoms and improve the quality of life for patients with aortic stenosis.
- The decision to undergo treatment should take into account the patient's age, comorbidities, and frailty, as these factors can impact the effectiveness of the treatment and the patient's quality of life 5.
- The assessment of quality of life is an important aspect of patient care, and various tools are available to evaluate the impact of aortic stenosis and its treatment on patients' quality of life 5.