Treatment

There is a risk of Stokes-Adams attacks and sudden death in patients with aortic stenosis.

Symptomatic patients usually require valve replacement.

The treatment of asymptomatic patients is unresolved. If the systolic gradient across the aortic valve is greater than 70 mm Hg then most cardiologists recommend valve replacement.

If a patient is unfit for surgery then percutaneous transluminal valvuloplasty may be tried.

It is essential to give prophylactic antibiotics against infective endocarditis.

Asymptomatic patients should be advised to avoid competitive sports.#

NICE state with respect to management of aortic valve disease (1):

• offer surgery, if suitable (by median sternotomy or minimally invasive surgery), as first-line intervention for adults with severe* aortic stenosis, aortic regurgitation or mixed aortic valve disease and an indication for surgery who are at low or intermediate surgical risk **
• offer transcatheter aortic valve implantation (TAVI), if sutable, to adults with non-bicuspid severe aortic stenosis who are at high surgical risk or if surgery is unsuitable

* severity of valve disease is defined in line with the British Society of Echocardiography guidelines on the British Heart Foundation's website.

** is calculated using EuroSCORE II. People have low surgical risk if they score less than 4%, intermediate risk if they score between 4% and 8% and high risk if they score more than 8%

Notes:

• 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.

Reference:

• NICE (November 2021). Heart valve disease presenting in adults: investigation and management
• NICE (July 2017). Transcatheter aortic valve implantation for aortic stenosis