Aortic stenosis causes impaired outflow of blood from the heart and is usually progressive. The increased cardiac workload leads to left ventricular hypertrophy and heart failure. Symptoms of aortic stenosis typically include shortness of breath and chest pain on exertion. Mortality rates are high in symptomatic patients.
Surgical aortic valve replacement (SAVR) with an artificial (biological or mechanical) prosthesis is the conventional treatment for patients with severe symptomatic aortic stenosis who are well enough for surgery. Optimal medical care has traditionally been the only option for those whose condition is unsuitable for surgery. Aortic balloon valvuloplasty is occasionally used as bridging or palliative treatment. Transcatheter aortic valve implantation (TAVI) is another less invasive alternative treatment.
Patients for whom SAVR is suitable range from those considered to be high risk (for example, as defined in the PARTNER 1A trial) to those for whom the benefits of surgery clearly outweigh the risks of surgery. SAVR may not be suitable for patients because of medical comorbidities or technical considerations (for example, if the patient has a calcified aorta or scarring from previous cardiac surgery), which mean that the risks of SAVR outweigh the potential benefits.