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Timing of operation in asymptomatic severe aortic stenosis

Hari P Chaliki1, Morgan L Brown, Thoralf M Sundt

  • 1Mayo Clinic Arizona, Division of Cardiovascular Diseases, 13400 E. Shea Boulevard, Scottsdale, AZ 85255, USA. chaliki.hari@mayo.edu

Expert Review of Cardiovascular Therapy
|November 27, 2007
PubMed

Insights

Calcific aortic stenosis is the leading cause of aortic stenosis, often managed with surgery for symptomatic patients. Early surgery may benefit select asymptomatic individuals with severe stenosis.

Area of Science:

  • Cardiology
  • Valvular Heart Disease

Background:

  • Calcific aortic stenosis (CAS) is now the primary cause of aortic stenosis, surpassing rheumatic fever.
  • Hyperlipidemia is a significant risk factor contributing to the progression of CAS.

Purpose of the Study:

  • To review the current understanding and management of calcific aortic stenosis.
  • To identify patient subgroups who may benefit from early surgical intervention.

Main Methods:

  • Review of current American College of Cardiology/American Heart Association guidelines for severe aortic stenosis.
  • Analysis of factors indicating severity: peak velocity > 4 m/sec, mean gradient > 40 mmHg, valve area < 1.0 cm(2).
  • Evaluation of indicators for early surgery in asymptomatic patients, including aortic valve calcium and exercise testing.

Main Results:

  • Severe aortic stenosis is defined by specific hemodynamic criteria.
  • Symptomatic patients with severe aortic stenosis have a poor prognosis without timely aortic valve surgery.
  • Asymptomatic patients with high aortic valve calcium or positive exercise tests may benefit from early surgery.

Conclusions:

  • Aortic valve surgery offers low risk and improved outcomes for selected asymptomatic patients with severe CAS due to advancements in techniques and prosthetics.
  • Percutaneous aortic valves are currently indicated for very high-risk symptomatic patients, with potential for expanded use.
  • Future molecular cardiology advancements may offer novel preventative therapies for CAS.

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