Indications for Surgical Aortic Valve Replacement

Abstract

The average survival rate was 3 years after the onset of angina pectoris in patients with severe Aortic Stenosis (AS) [1]. The average survival rate after the onset of syncope in patients with severe AS was 3 years [1]. The average survival rate after the onset of heart failure in patients with severe AS was 1.5 to 2 years [1]. Patients with symptomatic severe valvular AS have a poor prognosis [1-4]. At the National Institutes of Health, 52% of patients with symptomatic severe valvular AS not operated on were dead at 5 years [1]. At 10-year followup, 90% of these patients were dead. At 4-year follow-up of patients aged 75 to 86 years in the Helsinki Aging Study, the incidence of cardiovascular mortality was 62% in patients with severe AS [2]. At 4-year follow-up, the incidence of total mortality was 76% in patients with severe AS [2]. In a prospective study, at 19-month follow-up (range 2 to 36 months), 90% of 30 patients with heart failure associated with unoperated severe AS and a normal left ventricular ejection fraction were dead [3]. At 13-month follow-up (range 2 to 24 months), 100% of 18 patients with heart failure associated with unoperated severe AS and an abnormal left ventricular ejection fraction were dead [3]. In a prospective study, at 20-month follow-up of 40 elderly patients with severe AS, heart failure, syncope, or angina pectoris was present in 36 of 37 patients (97%) who developed new coronary events and in none of 3 patients (0%) without new coronary events [4]. Surgical Aortic Valve Replacement (AVR) is the procedure of choice for symptomatic patients with severe AS (an aortic valve area less than 1.0 cm 2 ) with a Class I indication [5]. Other Class I indications for AVR in patients with severe AS include 2) patients undergoing coronary artery bypass graft surgery, 3) patients undergoing surgery on the aorta or other heart valves, and 4) patients with a left ventricular ejection fraction less than 50% [5]. Patients with moderate AS undergoing coronary artery bypass graft surgery or surgery on the aorta or other heart valves have a Class IIa indication for AVR [5].