Percutaneous and surgical treatment of aortic stenosis

Abstract

Aortic stenosis due to calcific degeneration is the most common valvular disorder among the elderly. With the growing elderly population, the prevalence of this disease will continue to increase. Based on converging lines of evidence linking calcific aortic stenosis with atherosclerosis, there has been interest in drug therapy to slow the progression of aortic stenosis. Unfortunately, recently completed prospective trials have been disappointing. Mechanical measures remain the principal form of therapy. Among percutaneous techniques, aortic valvuloplasty provides only transient and modest benefit at a significant risk of stroke and vascular injury. However, aortic valvuloplasty can play a useful role in stabilizing patients who require additional attention prior to definitive surgery. Building on this foundation, a bold new technique of percutaneously implanting a balloon-mounted valve has been developed. Although promising, there have been relatively few patients treated in this fashion (at a single center) and with only limited follow-up. Surgical treatment, specifically valve replacement, is still the definitive treatment of choice for patients with symptomatic aortic stenosis. Surgeons and patients must choose between a variety of models of both tissue and mechanical valves and a variety of surgical approaches. Recent trends include the use of tissue valves in increasingly younger patients and continued interest in alternatives to full median sternotomy in approaching the valve.