Treatment

AS is a progressive condition that is definitively treated with aortic valve replacement or repair, the urgency of which depends on disease severity.

• Symptomatic and/or severe AS: Aortic valve replacement or repair is usually indicated.

• Asymptomatic or mild-to-moderate AS: usually treated conservatively; consider early aortic valve replacement in select patients.

• All patients

  • Provide supportive care: e.g., manage comorbidities (e.g., hypertension, diabetes), monitor progression with serial echocardiograpy, provide IE prophylaxis for at-risk patients.

  • Manage critical complications of AS (e.g., acute heart failure) with individualized critical care focusing on acute stabilization and expedited surgical trreatment.

• Symptomatic patients with severe, high-gradient AS

• Asymptomatic patients with severe AS and:

  • Significantly ↓ LVEF

  • Undergoing cardiac surgery for other indications

• Surgical AVR (SAVR) is recommended for patients with:

  • Age < 65 years

  • Life expectancy > 20 years

  • Low to moderate surgical risk

• Transcatheter AVR (TAVR)

  • Recommended for patients with:

    • Age > 80 years

    • Life expectancy < 10 years

    • High or prohibitive surgical risk and predicted survival of > 12 months [9]

• Percutaneous balloon valvuloplasty [9]

  • May be used in children, adolescents, and young adults

  • Limited role in older patients

The following can rapidly lead to decompensation and circulatory collapse in patients with severe AS:

• Cardiogenic shock

• Acute heart failure (AHF)

• Atrial fibrillation with RVR

• Asymptomatic patients: Mortality rate is < 1% in a given year. [24]

• Symptomatic patients: Mortality rate in the first 2 years is > 50% if left untreated.