[Spontaneous course of aortic valve disease and indications for aortic valve replacement]

190 adult patients with aortic valve disease have been followed up after initial cardiac catheterization until death or aortic valve replacement (event-free survival). Neither hemodynamic severity nor symptoms alone were reliable predictors of survival, but the combination of both was very helpful. In the presence of hemodynamically and symptomatically severe aortic stenosis and aortic regurgitation only 40% of patients survived for two years, but patients with hemodynamically severe aortic stenosis but with few or no symptoms had 100% survival at two years and 75% were event free at five years. In hemodynamically severe aortic regurgitation two asymptomatic patients died within the first two years (94% survival at two years) and 65% were event free at five years. In the absence of coronary artery disease there was no mortality within the first two years in moderate or mild stenosis and regurgitation regardless of symptomatic status. Hemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with hemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without significant risk of sudden death. In severe aortic regurgitation, the decision to perform surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of the risk of sudden death. In the absence of coronary artery disease, hemodynamically moderate aortic valve disease does not require valve surgery on prognostic grounds.