ABSTRACT
Introduction and background e natural history of aortic stenosis is well established. Once moderate disease is present (dened as a jet velocity greater than 3.0 m/s, Table 24.1), the expectation is gradual progression of approximately 0.3 m/s or 1 cm2/year.1,2 For patients with severe aortic stenosis (valve area <1 cm2, jet velocity >4 m/s, or mean gradient >40 mmHg), the cardinal symptoms of cardiac syncope, angina, or exertional dyspnea portend a very poor prognosis if untreated.3 Surgical aortic valve replacement (AVR) has long been recognized as the standard treatment modality, with favorable longterm outcomes extending beyond 30 years. e American College of Cardiology/American Heart Association and European Society of Cardiology guidelines both recommend surgical AVR for patients with severe, symptomatic aortic stenosis and for those with asymptomatic disease with coexisting le ventricular dysfunction or undergoing cardiac surgery for another reason.4,5
While most patients with symptomatic, severe aortic stenosis are appropriate candidates for surgical valve replacement, many patients, particularly those of advanced age, have issues placing them at elevated surgical risk. Comorbid conditions such as chronic lung disease, peripheral vascular or cerebrovascular disease, diabetes, renal insuciency, and le ventricular dysfunction all gure into a patient’s individual risk for surgery. ese and other factors have become part of objective risk stratication tools, such as the Society of oracic Surgery (STS) or
EuroSCORE, that aim to quantify risk and identify those who would likely not have an overall benet from surgery. Other conditions, such as liver disease and frailty, are not necessarily included in traditional risk stratication, but they are oen a part of the subjective evaluation of surgical risk stratication.
