Guidelines for the Management of Severe Aortic Stenosis

Dear Colleagues,

Aortic stenosis (AS) is the most frequently encountered valvular heart disease. The therapeutic decision of aortic stenosis depends on patient’s symptoms, ventricular function, and severity of AS. Current therapeutic options include surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for symptomatic patients with severe AS. Long latency from initial diagnosis to symptom onset has been reported; however, once symptomatic, the survival rates are poor for patients without treatment, and despite appropriate treatment, the outcomes vary and depend on patients’ clinical characteristics. In most asymptomatic patients, watchful waiting with regular clinical and imaging follow-up is recommended, given the surgical risk is greater.

Furthermore, diagnosing patients with bioprosthetic aortic valve dysfunction is challenging and difficult, requiring good Doppler signal and appropriate echocardiographic windows. Reduced left ventricular systolic function, stroke volume and patient prosthesis mismatch further complicate the assessment of bioprosthetic aortic valve dysfunction.

However, echocardiography remains the cornerstone for the evaluation of AS for the majority of patients. Advanced multimodality cardiovascular imaging is essential to further guide early decision making and to confirm different stages of disease. There are several other parameters including valve anatomy/morphology, valve hemodynamics, changes in vasculature and ventricles, exercise testing and serum BNP levels to help guide early interventions.

We believe the readers of the Journal of Clinical Medicine will be interested in this Special Issue. We attempt to address the benefits of various multimodality imaging in diagnosing and guiding towards appropriate treatment strategy. Moreover, we will try to review various current treatment options, including SAVR/TAVR, bioprosthetic valve durability and future directions.

Dr. Srikanth Koneru
Guest Editor

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• aortic stenosis
• low flow low gradient AS
• TAVR
• SAVR
• multimodality imaging
• valve in valve TAVR
• patient prosthesis mismatch