Current Management and Therapy of Severe Aortic Stenosis and Future Perspective

• Published in: Journal of Atherosclerosis and Thrombosis 2024/10/01, Vol.31(10), pp.1353-1364
• Main Authors: Takeji, Yasuaki, Tada, Hayato, Taniguchi, Tomohiko, Sakata, Kenji, Kitai, Takeshi, Shirai, Shinichi, Takamura, Masayuki
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Aortic Valve - pathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Aortic Valve Stenosis - therapy; Disease Management; Disease Progression; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - trends; Humans; Preventive therapy; Review; Severity of Illness Index; Transcatheter Aortic Valve Replacement - methods
• ISSN: 1340-3478; 1880-3873; 1880-3873
• DOI: 10.5551/jat.RV22023

Intervention for severe aortic stenosis (AS) has dramatically progressed since the introduction of transcatheter aortic valve replacement (TAVR). Decades ago, controversies existed regarding comparing clinical outcomes between TAVR and surgical aortic valve replacement (SAVR) in various risk profiles. Recently, we discussed the durability of transcatheter heart valves and their lifetime management after aortic valve replacement (AVR). Regarding the management of AS, we discuss the appropriate timing of intervention for severe aortic stenosis, especially in asymptomatic patients. In spite of dramatic progression of intervention for AS, there are no established medications available to prevent or slow the progression of AS at present. Basic research and genome studies have suggested several targets associated with the progression of aortic valve calcification. Randomized controlled trials evaluating the efficacy of medications to prevent AS progression are ongoing, which might lead to new strategies for AS management. In this review, we summarize the current management of AS and the drugs expected to prevent the progression of AS.