The current diagnosis and treatment of patients with aortic valve stenosis

• Published in: Future cardiology 2021-09, Vol.17 (6), p.1143-1160
• Main Author: Henning, Robert J
• Format: Article
• Language: English
• Subjects: aortic mean pressure gradient; aortic stenosis management; aortic stenosis signs; aortic stenosis symptoms; aortic valve area; aortic valve calcium score; bicuspid aortic valve; bioprosthetic aortic tissue valves; calcific aortic valve degeneration; echocardiographic transaortic flow velocity; EuroScore; mechanical aortic valves; rheumatic aortic stenosis; Society Thoracic Surgery Prediction of Mortality Score; surgical aortic valve replacement (SAVR); TAVI trials; transthoracic aortic valve implantationt (TAVI)
• ISSN: 1479-6678; 1744-8298
• DOI: 10.2217/fca-2020-0140

Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm , peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized. The aortic valve is one of the four valves within the heart. Aortic valve stenosis is a problem that can occur in middle age and elderly people and limits the amount of oxygen-rich blood that can be pumped by the heart to the tissues of the body. Aortic valve stenosis can cause symptoms such as shortness of breath, chest discomfort, dizziness, fainting and difficulty exercising. Treatment consists of replacement of the aortic valve with a mechanical, pig or cow valve during open heart surgery. Alternatively, a catheter (tube) with a tissue valve can be passed through a peripheral artery into the heart for placement of a new aortic valve. The catheter valve replacement option has significantly reduced the side effects and death rate of patients who undergo aortic valve replacement for aortic valve stenosis.