What is aortic stenosis?
Aortic valve stenosis (AS) is a disease of the aortic valve in which the opening of the valve is narrowed (stenotic).
This typically results from calcium that is deposited in the valve as people age. The calcium causes narrowing of the valve and prevents it from opening normally.
The normal size of the aortic valve is the size of a half dollar; a severely stenotic valve may be the size of a dime or smaller.
What are the symptoms of aortic stenosis?
Narrowing of the aortic valve increases the effort required by the heart to adequately pump blood to the body. Over time heart function will deteriorate, and the patient will develop symptoms. Symptoms include:
If untreated, 50% of patients with severe aortic stenosis die 2 years after symptoms are detected.
What is the natural history of aortic stenosis?
If untreated, the interval from onset to death varies by symptoms
Who is a candidate for TAVR?
Traditional surgical aortic valve replacement (SAVR) continues to be associated with excellent outcomes and remains the gold standard for treatment of severe aortic stenosis. However, catheter-based procedures are emerging as viable option all for patients with aortic stenosis regardless of surgical risk.
What are the causes of aortic stenosis?
Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include calcification of a congenital bicuspid aortic valve (30-40% of cases) and acute rheumatic fever (less than 10% of cases).
How common is aortic stenosis?
Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% of people over age 85 have aortic valve stenosis. The prevalence is increasing with the aging population in North America and Europe.
It is estimated that in the US:
What is the treatment for aortic stenosis?
The only effective, durable treatment for aortic stenosis is aortic valve replacement (AVR). There is no medication that will reverse or prevent the progression of aortic stenosis.
Aortic valve replacement (AVR) is safe and highly effective treatment. AVR can be performed surgical, minimally invasvively or via a catheter-based approach (aka TAVR). Typically, surgical and minimally invasive AVR is recommended for lower-risk patients, while transcatheter aortic valve replacement (TAVR) is generally recommended for higher risk and advanced-age patients.
In order to determine the most appropriate treatment for the patient, a comprehensive evaluation is performed including assessment of the aortic valve, peripheral blood vessels, the aorta, blood vessels in the heart, heart function, lung function, and overall well-being. Typically, this evaluation is completed in a single day.