Severe Aortic Stenosis
Aortic stenosis is a narrowing of the aortic valve opening that restricts normal blood flow to the entire body. It is estimated to be prevalent in up to 7% of the population over the age of 65.1 It is a common public health problem affecting millions of people in the United States.3 It is also more likely to affect men than women. 80% of adults with symptomatic aortic stenosis are male.1
After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.1
*Otto CM. Timing of aortic valve surgery. Heart. 2000;84:211-18.
Aortic stenosis is a slow, progressive disorder that starts with aortic sclerosis and progresses to aortic stenosis where there is severe calcification of the leaflets.
Factors associated with an increased risk of aortic valve disease include the following:2
- Increasing age
- Elevated lipoprotein A
- Elevated LDL cholesterol
- Shortness of breath
- Difficulty when exercising
- Lightheadedness, dizziness, and fainting
- Swollen ankles and feet
- Rapid or irregular heartbeat
- Palpitations - an uncomfortable awareness
of the heart beating rapidly or irregularly
However, heart valve disease may occur with no outward symptoms.
Quality of life is significantly impacted in patients with symptomatic aortic stenosis
Detection and estimation of disease severity can often be achieved by auscultation.
- Audible systolic heart murmur
- Longer duration with later peak is consistent with more severe stenosis
- Loudness of the murmur does not necessarily correlate with the severity of stenosis
- Soft or absent second heart sound
- Delayed carotid upstroke
Patients may live with aortic stenosis for many years during a latent asymptomatic period that precedes the point that symptoms of the disease develop. However, after patients begin experiencing symptoms, prompt treatment becomes necessary.
Cohort B - The PARTNER Trial
Standard Therapies Are Inadequate for Severe Aortic Stenosis
Cohort B - The PARTNER Trial
- In inoperable patients with severe aortic stenosis who did not receive a valve replacement, 50% died
The only effective treatment for severe aortic stenosis is aortic valve replacement.6
If a patient is showing symptoms, treatment is crucial. There are no medications to reverse or slow the progression of aortic stenosis.
Aortic Valve replacement is the only effective treatment considered a Class I recommendation by the American College of Cardiology and the American Heart Association.6 Patients today who develop severe aortic stenosis have multiple treatment options.
Due to the dismal nature of the disease, diagnosis and treatment are crucial. Patients today with severe aortic valve stenosis have multiple treatment options. For high-risk patients and those who are not suitable for surgical aortic valve replacement, another option is now available - transcatheter aortic valve replacement (TAVR). TAVR is a less invasive procedure that does not require open heart surgery and results in lengthening patient's lives.