[Aortic stenosis].

Abstract

The diagnosis of severe aortic stenosis requires consideration of AVA together with flow rate, pressure gradients (the most robust measurement), ventricular function, size and wall thickness, degree of valve calcification and blood pressure, as well as functional status. The assessment of the severity of aortic stenosis in patients with low gradient and preserved ejection fraction remains particularly challenging. The strongest indication for intervention remain symptoms of aortic stenosis (spontaneous or on exercise testing). The presence of predictors of rapid symptom development can justify early surgery in asymptomatic patients, particularly when surgical risk is low. Although current data favour TAVI in elderly patients who are at increased risk for surgery, particularly when a transfemoral access is possible, the decision between TAVI and SAVR should be made by the Heart Team after careful, comprehensive evaluation of the patient, weighing individually risk and benefit.