Management of severe aortic stenosis

Emilija Bernotaitė1, Lolita Nagytė1

1Lithuanian University of Health Sciences. Academy of Medicine. Faculty of Medicine.

Background. Aortic stenosis (AS) is one of the most common heart valve diseases who usually develops later in life. About 2% of the population aged 65 years or older have AS and another 25-30% have aortic sclerosis. The classic triad of symptoms: angina, dyspnea and syncope. Severe AS is diagnosed when peak aortic jet velocity ≥4 m/s, a mean transvalvular gradient ≥40 mmHg, and/or an aortic valve area <1,0 cm2 (0,6 cm2/m2). Patients with symptomatic severe AS have a two-year mortality rate of 50 percent without intervention. Therefore, it is important to provide effective treatment in a timely manner that alleviates the symptoms and prolongs the patients’ survival. Aim: to select and analyze expert developed and universally accepted guidelines for the treatment of severe AS and summarize the current knowledge related to the medical management of severe AS. Material and the methods: a review of the literature was conducted using the electronic medical database “PubMed” (MEDLINE), selecting publications which contains expert recommendations on the treatment of severe AS. A combination of the key terms “severe aortic stenosis”, “transcatheter aortic valve implantation”, “surgical aortic valve replacement” was used. Conclusion: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) is the major treatments of severe AS, which both provide symptomatic relief and prolong survival. Although open-heart surgery is the gold standard in treating severe AS but for patients at high risk or with old age is recommended to do TAVI. Most patients with AS are elderly and have comorbidities, which makes the treatment decision difficult and requires individual judgment in each case.

Keywords: severe aortic stenosis, transcatheter aortic valve implantation, surgical aortic valve replacement.