Aortic Stenosis for Providers
Nine percent of the U.S. population age 70 or above has aortic stenosis and the number rises to 13 percent over age 75.
Aortic stenosis is a malignant process with known progression and poor prognosis if untreated, especially when the patient is symptomatic. Aortic valve replacement (AVR) is the only accepted treatment. The survival advantage with surgery is clear.
The ACC/AHA Guidelines are clear:
- Symptomatic patients should have surgery
- Asymptomatic patients should have a stress test, and if abnormal, should have surgery
- Asymptomatic patients with ejection fraction < 50%, or aortic valve area < 0.6cm2, or aortic valve gradient > 60mmHg, or Vmax > 5m/s, and low expected operative mortality < 1% should have surgery.
- Low output/low gradient severe stenosis patient should have surgery
- Asymptomatic patients with normal ejection fractions and good stress tests are safe to follow with careful assessment for onset of symptoms
Learn more here:
ACC/AHA Indicators for AVR
Asymptomatic patients respond to stress testing
What happens if patients don't have surgery?
Outcomes of unoperated patients
Reasons for denying AVR
DASI Questionnaire may reveal symptoms
Timing of surgical evaluation improves with collaboration