Indications for aortic valve replacement in aortic stenosis

Aortic stenosis is a common condition, particularly in the elderly. The treatment is surgical, and any patient with symptomatic severe aortic stenosis should be considered for aortic valve replacement. Aortic stenosis causes an increase in afterload to the left ventricle, which when severe can lead to hemodynamic instability. Although the therapy of aortic stenosis is valve replacement, determining whether a patient has symptoms and accurately assessing the severity of stenosis can be difficult. The management of patients with severe aortic stenosis in the intensive care unit setting can be very challenging, particularly when comorbid medical conditions make aortic valve replacement difficult. This article reviews the diagnosis of aortic stenosis, methods of assessing symptoms and severity, and management of severe symptomatic stenosis, particularly in the intensive care unit setting. Components of the history that suggest symptomatic aortic stenosis are presented. The role of physical examination is discussed, as are the echocardiographic means of determining stenosis severity. Other means of assessing severity are addressed, as are circumstances in which there can be difficulty in interpretation, such as severe aortic stenosis and left ventricular dysfunction. Management of patients, focusing on the intensive care unit setting, is reviewed, with a focus on the timing of aortic valve replacement.