Treatment
Medical Therapy
����There are no proven medical treatments to prevent or delay the disease
process in the aortic valve leaflets. However, evaluation and modification
of cardiac risk factors is important in patients with aortic valve disease to
prevent concurrent coronary artery disease (CAD).
Balloon Aortic Valvuloplasty
����There has been no significant difference in long-term survival
demonstrated between patients undergoing balloon aortic valvuloplasty
and those undergoing medical therapy alone. Although balloon aortic
valvuloplasty as a stand-alone treatment is NOT recommended, it may still
be used in contemporary practice as a bridge to AVR, TAVR or decision.
Aortic Valve Replacement
����AVR offers symptomatic relief, improves long-term survival and is the only
effective treatment considered a Class I recommendation by ACCF/AHA
and ESC guidelines in adults with severe symptomatic AS.
����Mortality is under 3% for all patients undergoing AVR.
����With severe, symptomatic, calcific AS, AVR is the only effective treatment
that improves symptoms and prolongs survival. These results are partly
dependent on LV function. In the setting of LV dysfunction caused by
afterload mismatch, survival is still improved, although improvement in LV
function and resolution of symptoms might be incomplete after AVR.
����Mechanical valves are typically preferred in younger patients given their
reliable long-term durability. Bioprosthetic valves are generally preferred
in older patients who are unlikely to tolerate bleeding risk associated with
anticoagulation treatment and in whom a 15-year durability is reasonable.
Transcatheter Aortic Valve Replacement (TAVR)
����Although the technique and equipment continue to evolve, TAVR is a
complex procedure with many interlocking steps that require meticulous
attention to achieve optimal results and minimize complications.
����A foundational requirement of TAVR is a team-based approach to patient
care at a site with expertise in structural heart disease. Team members
will include patients and their families, cardiac anesthesiologists, heart
failure specialists, structural heart disease physicians, imaging specialists
and the nursing care team.
����Protocols should be defined for routine postprocedural care, as well as
management of specific problems and complications.
