Risk stratification and management of aortic stenosis with concomitant left ventricular dysfunction


DOI: 10.1007/s11936-007-0044-z

Cite this article as:
Steinhauser, M.L. & Stone, P.H. Curr Treat Options Cardio Med (2007) 9: 490. doi:10.1007/s11936-007-0044-z

Opinion statement

Aortic stenosis is a common clinical problem. The development of symptoms usually precedes the development of left ventricular (LV) dysfunction. Therefore, patients with concomitant severe aortic stenosis and LV dysfunction comprise a minority with this condition, albeit a clinically challenging group to manage. Because the only proven therapy for aortic stenosis is surgical valve replacement, the approach to the management of a patient with aortic stenosis and LV dysfunction primarily centers on risk stratification and the decision of whether to operate. Patients with aortic stenosis and low transvalvular gradients constitute a distinctly high-risk group, particularly when evidence of contractile reserve is absent after challenge with dobutamine. In the absence of any effective medical therapies, it is increasingly clear that even high-risk patients lacking contractile reserve may benefit from surgical valve replacement. However, evolving experimental percutaneous solutions may offer new management options for high-risk patients in the future.

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Cardiovascular DivisionBrigham and Women’s HospitalBostonUSA