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Asymptomatic Severe Aortic Valve Stenosis—When to Intervene: a Review of the Literature, Current Trials, and Guidelines

  • Valvular Heart Disease (TL Kiefer, Section Editor)
  • Published:
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Abstract

Purpose of Review

The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients.

Recent Findings

Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients.

Summary

Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.

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Authors and Affiliations

  1. Division of Cardiology - ACC Building 5th floor, University of Florida College of Medicine – Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA

    Andrés M. Pineda

  2. Division of Cardiology, Duke University Hospital, Durham, NC, USA

    Todd L. Kiefer

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  1. Andrés M. Pineda
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Correspondence to Andrés M. Pineda.

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Andrés M. Pineda and Todd L. Kiefer declare that they have no conflict of interest.

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Pineda, A.M., Kiefer, T.L. Asymptomatic Severe Aortic Valve Stenosis—When to Intervene: a Review of the Literature, Current Trials, and Guidelines. Curr Cardiol Rep 20, 129 (2018). https://doi.org/10.1007/s11886-018-1072-x

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