ABSTRACT
INTRODUCTION Surgical aortic valve replacement (SAVR) is the only validated therapy for aortic stenosis (AS) and represents the current standard of care. Aortic valve replacement (AVR) is the most frequently performed operation for acquired structural heart disease. In the United States, more than 56,000 underwent SAVR in 2005 alone (1), and with an aging population in Western countries this number is expected to rise considerably (Chap. 3). It is estimated that up to 33% of patients with severe aortic valve stenosis and related age and left ventricular dysfunction risk factors do not benefit from surgical therapy (2). There are two main reasons for the lack of surgical treatment of AS. First, the patients who meet the current treatment criteria are simply not referred to their surgical colleagues (approximately 45% of all U.S. AS patients). Second, the patients who meet the treatment criteria are perceived to be not eligible for surgery because they might appear to be “too sick” or “too old” for a reasonably safe intervention (approximately 22% of all U.S. AS patients). Therefore, only 33% of the patients with AS do meet the treatment criteria and are eligible for AVR surgery (3).
