Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis?

Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis?

It has been well known for many years that symptomatic patients with severe aortic stenosis have a very poor outcome. Average survival after the onset of symptoms has been reported to be less than 2 to 3 years. In this situation, valve replacement not only results in dramatic symptomatic improvement but also in good long-term survival. This holds true even for patients with already reduced left...

Asymptomatic Severe Aortic Stenosis with Normal Ejection Fraction: when the Early/Elective Surgery Might be the Choice?

Aortic valve replacement (AVR) therapy is clear in symptomatic AS patients, because it improves symptoms, LV function and survival. However, the indications for AVR in asymptomatic patients with severe AS are vague and the subject of ongoing debate. There are observational data that early AVR leads to favorable outcome compared to late (after symptom onset) surgery. Having in mind that operativ...

Should lung biopsies be performed in patients with severe asthma?

Asthma, and severe asthma, in particular, is increasingly recognised as a heterogeneous disease. Identifying these different phenotypes of asthma and assigning patients to phenotype-specific treatments is one of the current conundrums in respiratory medicine. Any diagnostic procedure in severe asthma (or any disease) should have two aims: 1) better understanding or identifying the diagnosis, an...

Stress Testing in Patients with Asymptomatic Severe Aortic Stenosis

Role of BNP in patients with severe asymptomatic aortic stenosis.

Senile degenerative valvular aortic stenosis affects approximately 2% of the population over the age of 65. Aortic stenosis impedes left ventricular emptying and increases left ventricular wall stress, which leads to elevation of brain natriuretic peptide (BNP) levels. Aortic stenosis progresses slowly, allowing the left ventricle to develop concentric hypertrophy, which normalizes wall stress....