Aortic stenosis management in 2021: better teaming up than fighting between specialties

Abstract

Management of severe symptomatic aortic stenosis over the decades. Left upper panel: 1980–1990. Valve replacement reverses the dismal outcome of severe symptomatic AS (adapted from Horstkotte and Loogen3). Right upper panel: 1990–2000. Many patients do not receive AVR because of older age and comorbidities (graph based on data from Charlson et al.,5 Iung et al.,6 and Bouma et al.7). Left lower panel: 2000–2010. TAVI evolves as an alternative to SAVR, RCTs demonstrate non-inferiority (adapted from Jorgensen et al.13 and Makkar et al.14). Right lower panel: 2010–2020. The number of AVRs more than doubles and in-hospital mortality decreases for SAVR and TAVI. AS, aortic stenosis; AVR, aortic valve replacement; RCT, randomized controlled trial; TAVI, transcatheter aortic valve implantation; TAVR, transcatheter aortic valve replacement.