What is the treatment for aortic stenosis?
When heart valves are severely malformed or destroyed, there is no medicine to reverse or mend the damage. In most cases, surgery on the malfunctioning valve can help alleviate symptoms.
Specific treatment for aortic stenosis will be determined in consultation with a cardiologist and cardiac surgery expert in valve disease based on:
For patients with less advanced disease, follow-up echocardiography is recommended as follows, for patients with:
In advanced stages, surgery is required to correct this problem. There is no medical treatment to reverse aortic stenosis. Surgical treatment is indicated in
Heart valve replacement: When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves:
Mechanical valves are made of metal, plastic, or another artificial material and thus have greater durability. The downside is that it requires the patient to remain on anticoagulation for the rest of their life. They are traditionally recommended for patients:
Tissue valves do not require long-term anticoagulation, but they are less durable. They are traditionally recommended for patients:
However durability of a tissue valve is age dependent, due to greater hemodynamic demands in younger. Structural valve deterioration in patients at 10 years:
Specific treatment for aortic stenosis will be determined in consultation with a cardiologist and cardiac surgery expert in valve disease based on:
- your overall health and medical history
- extent of the disease
- your signs and symptoms
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
For patients with less advanced disease, follow-up echocardiography is recommended as follows, for patients with:
- severe AS: yearly
- moderate AS: every 3 years
- mild AS: every 5 years
In advanced stages, surgery is required to correct this problem. There is no medical treatment to reverse aortic stenosis. Surgical treatment is indicated in
- Patient with severe AS and symptoms or those undergoing other cardiac surgery
- Patients with severe AS with heart dysfunction, defined by an ejection fraction < 50%
- Patients with severe or moderate AS undergoing cardiac surgery for coronary or other valvular heart disease.
Heart valve replacement: When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves, and mechanical valves:
Mechanical valves are made of metal, plastic, or another artificial material and thus have greater durability. The downside is that it requires the patient to remain on anticoagulation for the rest of their life. They are traditionally recommended for patients:
- < 60 years old
- patients who want to avoid reoperation
- patients are already on long-term anticoagulation for another reason
Tissue valves do not require long-term anticoagulation, but they are less durable. They are traditionally recommended for patients:
- > 60 years old
- patients who prefer to avoid anticoagulation for lifestyles reasons (eg extremely active lifestyle, recent GI bleed, childbearing age)
However durability of a tissue valve is age dependent, due to greater hemodynamic demands in younger. Structural valve deterioration in patients at 10 years:
- 0-40yo: 40%
- 40-69yo: 30%
- >70yo: 10%
