[Aortic valve stenosis in the aged--replacement or dilatation?]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Context:

• Severe symptomatic aortic stenosis presents a critical clinical challenge with high mortality rates.
• Percutaneous transluminal aortic valvuloplasty (PTAV) offers initial relief but is often limited by restenosis.
• Aortic valve surgery is the established gold standard treatment for aortic stenosis.

Purpose:

• To evaluate the efficacy and outcomes of aortic valve surgery versus percutaneous transluminal aortic valvuloplasty in severe aortic stenosis.
• To identify patient subgroups who may benefit from valvuloplasty as a palliative or bridging therapy.

Summary:

• Aortic valve surgery demonstrates superior long-term outcomes and is the preferred treatment for severe aortic stenosis, even in elderly patients.
• Percutaneous transluminal aortic valvuloplasty has a high initial success rate but suffers from frequent restenosis and significant mortality within months.
• High-risk patients (NYHA IV, severe coronary heart disease, LVEF < 50%) face increased surgical mortality, making valvuloplasty a potential palliative or bridging strategy.

Impact:

• Aortic valve surgery provides durable and effective management for severe aortic stenosis, significantly improving patient survival and quality of life.
• Valvuloplasty can be a valuable therapeutic option for select high-risk patients, offering symptom relief and potentially extending time to definitive surgical intervention.
• This evidence guides clinical decision-making in managing severe aortic stenosis, optimizing treatment selection based on patient-specific risk factors and comorbidities.