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Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

We aim to provide the cardiovascular clinician with an update on the classification and diagnosis of severe AS and an evidence-based guide to the treatment options available for severe, symptomatic AS.

Recent findings

The classification of AS is evolving with increasing recognition of hemodynamically distinct AS subtypes and the importance of transvalvular flow in both the diagnosis and management of severe AS. Transcatheter aortic valve replacement (TAVR) has continued to expand its safety and efficacy to include patients with symptomatic, severe AS at low risk for surgical AVR (SAVR). There is emerging data supporting the use of TAVR among patients with asymptomatic, severe AS, bicuspid aortic valve (BAV) anatomy, and surgical bioprosthetic failure, but additional studies are needed.

Summary

As treatment options for managing patients with symptomatic, severe AS continue to grow at a rapid rate, it is essential to improve the recognition and diagnosis of the spectrum of clinical and hemodynamic presentations of severe AS. Despite the rapid expansion of TAVR, there remains a role for SAVR among a unique subset of patients. Future research should focus on optimizing the timing of valvular intervention while ensuring the acquisition of longer-term data on the durability of TAVR.

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Abbreviations

AS:

aortic stenosis

AVA:

aortic valve area

Q:

flow rate

LF:

low flow

LG:

low gradient

LVEF:

left ventricular ejection fraction

MDCT:

multidetector computed tomography

MG:

mean gradient

References and Recommended Reading

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  1. Massachusetts General Hospital, Harvard Medical School, Yawkey Center for Outpatient Care, Suite 5800 32 Fruit Street, Boston, MA, 02114, USA

    Daniela Crousillat MD, Mayooran Namasivayam MBBS, PhD & Jonathan J. Passeri MD

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Crousillat, D., Namasivayam, M. & Passeri, J.J. Severe, Symptomatic Aortic Stenosis: an Update on the Diagnostic and Treatment Tools in Our Arsenal. Curr Treat Options Cardio Med 22, 49 (2020). https://doi.org/10.1007/s11936-020-00847-5

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