title: Assessing the risk of aortic valve replacement for severe aortic stenosis in the transcatheter valve era.
abstract: Surgical aortic valve replacement had been the only definitive treatment of severe aortic stenosis before the availability of transcatheter valve technology. Historically, many patients with severe aortic stenosis had not been offered surgery, largely related to professional and patient perception regarding the risks of operation relative to anticipated benefits. Such patients have been labeled as "high risk" or "inoperable" with respect to their suitability for surgery. The availability of transcatheter aortic valve replacement affords a new treatment option for patients previously not felt to be optimal candidates for surgical valve replacement and allows for the opportunity to reexamine the methods for assessing operative risk in the context of more than 1 available treatment. Standardized risk assessment can be challenging because of both the imprecision of current risk scoring methods and the variability in ascertaining risk related to operator experience as well as local factors and practice patterns at treating facilities. Operative risk in actuality is not an absolute but represents a spectrum from very low to extreme, and the conventional labels of high risk and inoperable are incomplete with respect to their utility in clinical decision making. Moving forward, the emphasis should be on developing an individual assessment that takes into account procedure risk as well as long-term outcomes evaluated in a multidisciplinary fashion, and incorporating patient preferences and goals in a model of shared decision making.
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN. Electronic address: mathew.verghese@mayo.edu.
authors: Verghese
authors: V
authors: Mathew
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
authors: Rakesh M
authors: RM
authors: Suri
authors: Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY.
authors: Martin B
authors: MB
authors: Leon
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Vuyisile T
authors: VT
authors: Nkomo
authors: Baylor Health Care System, Plano, TX.
authors: Michael J
authors: MJ
authors: Mack
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: Charanjit S
authors: CS
authors: Rihal
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors: David R
authors: DR
authors: Holmes
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index