Asymptomatic Severe Aortic Stenosis with Left Ventricular Dysfunction: Watchful Waiting or Valve Replacement?

Abstract

Aortic stenosis is the most common valvular heart disorder in older adults. Patients with severe aortic stenosis are generally treated nonsurgically if asymptomatic and referred to aortic valve replacement when symptoms develop. However, patients with severe asymptomatic aortic stenosis with left ventricular dysfunction may benefit from early aortic valve replacement. Although operative mortality in patients with severe aortic stenosis and left ventricular dysfunction is greater than in patients with preserved left ventricular function, the overall mortality risk is substantially lower than that of watchful waiting. Operative risk in patients with severe aortic stenosis and left ventricular dysfunction is often overestimated and, consequently, most are not referred to surgery despite clinical data in support of early aortic valve replacement. Asymptomatic patients with echocardiographically confirmed severe aortic stenosis and left ventricular dysfunction should be referred for aortic valve replacement.