Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal
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(2020) 22:49
Valvular Heart Disease (J Dal-Bianco, Section Editor)
Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal Daniela Crousillat, MD Mayooran Namasivayam, MBBS, PhD Jonathan J. Passeri, MD* Address * Massachusetts General Hospital, Harvard Medical School, Yawkey Center for Outpatient Care, Suite 5800 32 Fruit Street, Boston, MA, 02114, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Valvular Heart Disease Keywords Aortic stenosis I Symptoms I Treatment I Surgical aortic valve replacement I Transcatheter aortic valve replacement
Abstract Purpose of review We aim to provide the cardiovascular clinician with an update on the classification and diagnosis of severe AS and an evidence-based guide to the treatment options available for severe, symptomatic AS. Recent findings The classification of AS is evolving with increasing recognition of hemodynamically distinct AS subtypes and the importance of transvalvular flow in both the diagnosis and management of severe AS. Transcatheter aortic valve replacement (TAVR) has continued to expand its safety and efficacy to include patients with symptomatic, severe AS at low risk for surgical AVR (SAVR). There is emerging data supporting the use of TAVR among patients with asymptomatic, severe AS, bicuspid aortic valve (BAV) anatomy, and surgical bioprosthetic failure, but additional studies are needed. Summary As treatment options for managing patients with symptomatic, severe AS continue to grow at a rapid rate, it is essential to improve the recognition and diagnosis of the spectrum of clinical and hemodynamic presentations of severe AS. Despite the rapid expansion of TAVR, there remains a role for SAVR among a unique subset of patients. Future research should focus on optimizing the timing of valvular intervention while ensuring the acquisition of longer-term data on the durability of TAVR.
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Curr Treat Options Cardio Med
(2020) 22:49
Introduction Aortic stenosis (AS) is present in up to 12% of adults greater than 75 years of age, of which 3.4% have hemodynamically significant severe AS [1]. Importantly, the prevalence of AS is projected to continue to increase due to a growing aging population. In the last decade, significant advancements have been made toward improving the accuracy of the diagnosis and classification of AS into different prognostically significant subtypes [2]. AVR remains the only treatment option for symptomatic, severe AS as no medical therapy to date has demonstrated efficacy in the reduction or regression of hemodynamically significant AS [3, 4]. The now widespread availability of transcatheter aortic valve replacement (TAVR) first improved the prognosis for patients previously deemed too high risk for surgical aortic valve replacement (SAVR) [5] and has now expanded to patients at low surgical risk for SAVR [6••, 7••]. However, there is still an important role for SAVR am
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