Moderate Aortic Stenosis: What is it and When Should We Intervene?

Abstract

Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis in the presence of symptoms or a left ventricular ejection fraction <50%. However, patients with less than severe aortic stenosis may also experience symptoms and recent literature suggests that the prognosis is not as benign as previously reported. There are no recommendations for patients with moderate aortic stenosis and left ventricular dysfunction, despite the high associated morbidity and mortality. There is also some evidence that these patients may benefit from early aortic valve intervention. It is recognised that aortic stenosis not only affects the valve but also has a complex myocardial response. This review discusses the natural history of moderate aortic stenosis along with the role of multimodality imaging in risk stratification in these patients.

Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

“…33 Beyond replicating our broad findings in other large clinical cohorts, future research is needed to better delineate the clinical trajectory and cause of death of individuals affected by mild-to-moderate forms of the disease. [9][10][11]24 Although we report on the pattern of premature mortality and YLL associated with progressively worse aortic stenosis within an Australian clinical cohort, our findings are broadly generalisable to other countries with a large burden of disease imposed by aortic stenosis, including the UK 5 and countries in continental Europe and North America. 4 The individual and societal imperative to more readily detect and clinically manage less severe forms of this common clinical condition to reduce the societal cost of future premature mortality, as well as a probable high burden of related health expenditure, is likely to apply to any country with substantial population ageing.…”

“…9 However, there remains minimal evidence of the societal cost of progressive aortic valve disease. 10 Therefore, in this study, we firstly aimed to identify the sex-specific distribution of progressive aortic stenosis among older individuals being routinely investigated for heart disease. We then determined the association of progressive aortic stenosis with quality-adjusted life years (QALYs) lost due to premature mortality, compared with individuals presenting with normal aortic valve function.…”

“… 9 However, there remains minimal evidence of the societal cost of progressive aortic valve disease. 10 …”

Engineering Efforts to Refine Compatibility and Duration of Aortic Valve Replacements: An Overview of Previous Expectations and New Promises

“…They still remain today a relevant contributor of loss of physical comfort and reduction of longevity and result in a considerable socio-economic burden ( 1 , 2 ). Diseases of the cardiac valves can be divided into two main categories, namely congenital pathologies (e.g., the malformation of the aortic and pulmonary valves, the Ebstein's Anomaly, the Fallot tetralogy or the bicuspid aortic valve), with an impact especially during the neonatal period and infancy, and acquired pathologies which, depending on the etiology, can have an impact at all ages (i.e., the rheumatic or the infectious heart valve disease) or in the elderly (e.g., calcification of the mitral and aortic valves) ( 1 , 3 , 4 ). In this framework, a major contribution to the increase in the overall impact of cardiac valves pathologies worldwide is the rapid increase of conditions leading to the aortic valve (AoV) stenosis, specifically “calcific aortic valve disease” (CAVD)-a disease correlated primarily to aging ( 1 , 3 , 5 , 6 ) with an important sex-related component ( 7 ).…”

Orthopaedic cardiac considerations in emergency

“…The introduction of stoke volume, global strain and novel markers of diastolic dysfunction in standard preoperative evaluation of severe aortic stenosis could give a better risk stratification and define patients who will truly benefit from prophylactic aortic valve surgery/intervention [ 29 ]. Likewise, orthopaedic patients with mild aortic stenosis that would otherwise get cardiac clearance for surgery may prove to be, in fact, of very high risk in the presence of heart failure [ 31 ].…”