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Moderate aortic stenosis: culprit or bystander?

Varayini Pankayatselvan1, Inbar Raber2, David Playford3

  • 1Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Open Heart
|January 25, 2022
PubMed

Insights

Untreated moderate aortic stenosis (AS) poses significant mortality risks. Emerging data suggests aortic valve replacement (AVR) may be beneficial, challenging traditional views on managing this common valvular disease.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Cardiac Surgery

Background:

  • Non-rheumatic aortic stenosis (AS) is a prevalent valvular heart disease in developed nations.
  • Severe symptomatic AS guidelines recommend aortic valve replacement (AVR), but moderate AS management remains debated.
  • Historically, moderate AS was considered benign, with AVR risks outweighing benefits.

Purpose of the Study:

  • To review contemporary data on morbidity and mortality in moderate AS.
  • To evaluate the evolving risk/benefit paradigm for AVR in moderate AS.
  • To discuss current understanding, guidelines, and future directions for moderate AS management.

Main Methods:

  • Literature review of current epidemiological data.
  • Analysis of clinical outcomes and mortality risks associated with moderate AS.
  • Appraisal of evolving guidelines and periprocedural/perioperative outcomes for AVR.

Main Results:

  • Emerging data indicates substantial mortality risk in untreated moderate AS.
  • Improvements in AVR periprocedural and perioperative mortality have been observed.
  • Traditional risk/benefit assessments for moderate AS intervention are being challenged.

Conclusions:

  • Contemporary data necessitates re-evaluation of moderate AS management strategies.
  • The timing of AVR in moderate AS requires careful consideration based on updated evidence.
  • Further studies are needed to refine surveillance and intervention thresholds for moderate AS.

Keywords:
echocardiographyepidemiologytranscatheter aortic valve replacement

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