aortic stenosis

• related: Aortic Valve
• tags: #note

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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