Treating Moderate Aortic Stenosis: Too Early or Too Late?

Abstract

It is well established that symptomatic severe aortic stenosis (AS) carries a poor prognosis and requires valvular replacement for definitive treatment. While moderate AS has traditionally been thought of as a benign prelude to the aforementioned, recent data suggests that it is associated with increased morbidity and mortality. This article will consider treatment strategies for moderate AS, including early surgical and transcatheter aortic valve replacement and medical therapy. There are few randomized controlled trials dedicated to medical and surgical therapies for moderate AS. Statins, antihypertensive agents and bisphosphonates have not consistently demonstrated an effect on AS progression, timing of aortic valve replacement, or improvement in patient outcomes. Early surgical intervention for patients with concomitant left ventricular dysfunction has been studied in a retrospective manner and appears promising. Aside from the routine management of comorbidities (i.e., coronary artery disease, hypertension, hyperlipidemia), no specific treatment is recommended that is exclusively directed towards moderate AS. Clinicians should maintain a high vigilance for AS progression and the development of symptoms. Given the safety and efficacy of transcatheter aortic valve replacement, a randomized controlled trial is underway to evaluate its benefits in patients with moderate AS and left ventricular systolic dysfunction.