title: Asymptomatic severe aortic stenosis with left ventricular dysfunction: watchful waiting or valve replacement?
abstract: Aortic stenosis (AS) is the most common valvular heart disorder in older adults. Patients with severe AS are generally treated nonsurgically if asymptomatic and referred to aortic valve replacement when symptoms develop. However, patients with severe asymptomatic AS with left ventricular dysfunction may benefit from early aortic valve replacement. Although operative mortality in patients with severe AS and left ventricular dysfunction is greater than in patients with preserved left ventricular function, the overall mortality risk is substantially lower than that of watchful waiting. Operative risk in patients with severe AS and left ventricular dysfunction is often overestimated and, consequently, most are not referred to surgery despite clinical data in support of early aortic valve replacement. Asymptomatic patients with echocardiographic confirmation of severe AS and left ventricular dysfunction should be referred for aortic valve replacement.
authors.affiliation: Miller Scientific Consulting, Inc., 26 Portobello Road, Arden, NC 28704, USA. larry@millerscientific.com
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Miller
authors.forename: Larry D
authors.initials: LD
authors.lastname: Acers
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D058070:Asymptomatic Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D019468:Disease Management; D004452:Echocardiography; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D057832:Watchful Waiting
keywords: Aortic stenosis; Aortic valve replacement; Heart failure; Heart valve