26 Apr

The Natural History and Rate of Progression of Aortic Stenosis

The Natural History and Rate of Progression of Aortic StenosisSurgical therapy, although important and effective therapy for aortic stenosis, has its own inherent risks. In addition to operative morbidity and mortality, surgery in essence replaces one disease process with another. The burden of aortic stenosis is removed, but the patient is left with “prosthetic heart valve disease.” This latter disease is associated with a risk of thromboembolism, endocarditis, prosthetic valve failure, and hemorrhage if anticoagulation is required. On average, the risk of a serious prosthetic valve-related complication is estimated to be 1 to 2% per year. The challenge is to determine the inflection point at which surgical therapy will portend a better prognosis compared with medical therapy. To meet this challenge, one requires an accurate knowledge of the natural history of aortic stenosis treated medically vs the risks and long-term outcome of operative treatment. This review will summarize the natural history of aortic stenosis in terms of symptoms, mortality, and stenosis progression.
The Natural History of Aortic Stenosis
Much of our understanding of the natural history of aortic stenosis is derived from clinical studies performed in the era prior to the development of cardiac catheterization and hence lacks hemodynamic information. In studies done subsequent to our ability to derive invasive hemodynamic data and replace valves, the clinical course of aortic stenosis was often interrupted by valve replacement. As a result, our view of the natural history of aortic stenosis is largely retrospective, introducing inherent biases to patient selection into these studies. Over time, the primary etiology of aortic stenosis has changed from rheumatic to senile degeneration and calcification and our patient population is older and has more associated coronary artery disease. Thus, the external validity (patient generalizability) of earlier studies must be questioned.

Categories: Aortic Stenosis
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