Aortic stenosis: surveillance and valve intervention
THE CONTEXT
Management depends strongly on symptoms, with surveillance for asymptomatic disease and prompt valve replacement for symptomatic severe stenosis.
Conservative management and surveillance
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Asymptomatic patients have a good immediate prognosis irrespective of stenosis severity, and conservative management with continued review is appropriate.
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Moderate or severe stenosis should generally be reassessed with Doppler echocardiography every 6–12 months to detect progression.
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Reviews should typically occur every 3–6 months in older patients with heavily calcified valves and in those with increasingly severe stenosis or more rapid progression.
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Development of symptoms indicates a poor prognosis and warrants prompt surgery.
Valve intervention
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Symptomatic severe aortic stenosis requires prompt aortic valve replacement. Delay risks sudden death or irreversible deterioration in ventricular function.
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Old age is not a contraindication to valve replacement. Experienced centres report very good results even in patients in their eighties, particularly with transcatheter aortic valve implantation.
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Aortic balloon valvuloplasty is useful in congenital aortic stenosis but has limited value in older patients with calcific stenosis.
Mechanical prostheses
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All patients with a mechanical prosthesis require anticoagulation with vitamin K antagonists.