Asymptomatic aortic stenosis: management revisited.
Aortic stenosis (AS) is common and is the commonest reason for valve surgery in the Western hemisphere. Calcific or a degenerative process is the most common cause of this pathological process and increases with aging population. The current guidelines recommend aortic valve replacement (AVR) only for symptoms or LV dysfunction unless a concomitant cardiac surgery is planned There are no randomized studies to guide therapy. AVR is forbidden by guidelines in severe AS patients with no symptoms. The guidelines are based on an analysis of natural history studies of AS and risk and durability of AVR. We will analyze the basis of current recommendations, unreliability of symptoms for such an important decision and more contemporary data on the natural and unnatural history of asymptomatic aortic stenosis. Based on these data, we recommend that asymptomatic AS should not be a class III recommendation for AVR and surgical options should be considered in most of severe AS patients with high risk profiles.
Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA. ramdaspai@yahoo.com
Ramdas G
RG
Pai
Ajit D
AD
Pai
D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D014218:Triage