Calcific Aortic Valve Disease: Where Are We Now?

Calcific Aortic Valve Disease: Where Are We Now? Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the aging population of the developed world with projected disease burden expected to increase from 2.5 million in 2000 to 4.5 million in 2030. In CAVD, the leaflets become thick, stiff, scarred, and calcified, often covered with nodules on the surface facing the aorta. In general, symptoms of CAVD are minimal even as the valve narrows into aortic stenosis (AS), where pressure overload leads to progressive left ventricular hypertrophy and life-threatening symptoms: angina and syncope. This hemodynamic catastrophe results in heart failure and, without intervention, death within months to years. The mainstay of treatment for CAVD is surgical aortic valve replacement (AVR) with a mechanical or bioprosthetic valve. Limitations include increased complications attributable to anticoagulation and the need for reoperation because of the limited lifespan of prosthetic valves. Transcatheter AVR is currently reserved for patients with excess operative risk, but its indications are now expanding because of the minimally invasive nature of transcatheter AVR compared with surgical AVR. If transcatheter AVR becomes more routine, some hope it will reduce the need for repeat surgery. Tissue-engineered valve replacement, particularly in pediatric patients, holds great potential, but remains elusive after years of effort. Currently, there are no medical therapies for CAVD as alternatives to surgery, other than for complications, such as antibiotics for infections and vasodilators for acute decompensation.