Aortic-valve stenosis is a progressive condition; end-stage disease leads to death due to obstruction of left ventricular outflow. Aortic-valve replacement is the only effective therapy. ...Transcatheter aortic-valve replacement is appropriate in patients at very high surgical risk.
Valvular aortic stenosis is a progressive disease in which the end stage is characterized by obstruction of left ventricular outflow, resulting in inadequate cardiac output, decreased exercise capacity, heart failure, and death from cardiovascular causes. The prevalence of aortic stenosis is only about 0.2% among adults between the ages of 50 and 59 years but increases to 9.8% in octogenarians, with an overall prevalence of 2.8% in adults older than 75 years of age.
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Although mortality is not increased when aortic stenosis is asymptomatic, the rate of death is more than 50% at 2 years for patients with symptomatic . . .
Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. Because clinical decision-making is based on the echocardiographic assessment of its severity, it is essential ...that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. In the meantime, numerous new studies on aortic stenosis have been published with particular new insights into the difficult subgroup of low gradient aortic stenosis making an update of recommendations necessary. The document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice.
Valve replacement is the only effective treatment for adults with severe, symptomatic aortic stenosis. The ideal prosthetic valve would be associated with minimal risk and discomfort at implantation, ...would have hemodynamics similar to those of a normal valve, would not require anticoagulation, and would be durable for the patient’s lifetime. We are moving closer to this goal, as evidenced by sequential randomized clinical trials of transcatheter aortic-valve replacement (TAVR), initially in patients at prohibitive or high estimated risk for death with surgical aortic-valve replacement, then in patients at intermediate risk, and now — in the trials by Mack et al.
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