Biomaterial Database

Asymptomatic aortic stenosis: management revisited. 2011

Ramdas G Pai, and Ajit D Pai

Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA. ramdaspai@yahoo.com

Aortic stenosis (AS) is common and is the commonest reason for valve surgery in the Western hemisphere. Calcific or a degenerative process is the most common cause of this pathological process and increases with aging population. The current guidelines recommend aortic valve replacement (AVR) only for symptoms or LV dysfunction unless a concomitant cardiac surgery is planned There are no randomized studies to guide therapy. AVR is forbidden by guidelines in severe AS patients with no symptoms. The guidelines are based on an analysis of natural history studies of AS and risk and durability of AVR. We will analyze the basis of current recommendations, unreliability of symptoms for such an important decision and more contemporary data on the natural and unnatural history of asymptomatic aortic stenosis. Based on these data, we recommend that asymptomatic AS should not be a class III recommendation for AVR and surgical options should be considered in most of severe AS patients with high risk profiles.

UI	MeSH Term	Description	Entries
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001024	Aortic Valve Stenosis	A pathological constriction that can occur above (supravalvular stenosis), below (subvalvular stenosis), or at the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.	Aortic Stenosis,Aortic Valve Stenoses,Stenoses, Aortic,Stenoses, Aortic Valve,Stenosis, Aortic,Stenosis, Aortic Valve,Valve Stenoses, Aortic,Valve Stenosis, Aortic
D014218	Triage	The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment.	Triages
D017410	Practice Guidelines as Topic	Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.	Clinical Guidelines as Topic,Best Practices,Best Practice
D018570	Risk Assessment	The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)	Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments
D019918	Heart Valve Prosthesis Implantation	Surgical insertion of synthetic material to repair injured or diseased heart valves.	Implantation, Heart Valve Prosthesis