aortic stenosis

AS

  • latent disease and once develop symptoms, short life span < 2 years
  • aortic valve replacement only treatment
  • surgical AVR mortality in 30 days goes up with age, >10% with people > 80

balloon valvuloplasty

  • causes severe AR
  • stroke risk
  • marginal improvement in area
  • no benefit with AS, significant recurrence

  • SAVR for low and intermediate risk
  • TAVR approved for low risk in 2019
  • Pacemaker rate to 10-20%
  • 73% TAVI patients have new embolic lesions by MRI. Protected TAVR on study to see if can catch emboli

Guideline

  • severe AS or symptoms = AVR
    • SAVR for younger pt < 65 with longer life expectancy

    • 80 or life expectancy < 10, TAVR

  • asymptomatic patients: follow same recommendations

asymptomatic patients

  • TAVR if exercise stress test, changes on echo, EF < 50%
  • Early TAVR study, EVOLVED trial: asymptomatic patients undergo TAVR