A New Era in the Management of Aortic Stenosis

Aortic stenosis (AS) is a disease of the elderly with a prolonged, insidious development over decades. With an aging population in developed countries, the prevalence of AS is estimated at 5% to 7% among the elderly. Most commonly, AS results from calcification of the aortic valve beginning at the base of the cusps and extending to the leaflets, progressively restricting leaflet motion without true fusion of the commissures. Morbidity and mortality are very low from AS during its latency period. Once symptoms develop (angina, syncope or heart failure), the prognosis changes dramatically. Average survival is two to three years, with a high risk of sudden death. Aortic valve replacement (AVR) is therefore indicated (Class I recommendation) in virtually all symptomatic patients with severe AS unless serious comorbid conditions preclude surgery.