Surgery in asymptomatic aortic stenosis

Exercise testing is the key investigation

Aortic stenosis is the commonest valve disease in the developed world that requires surgery. In elderly people its prevalence is approximately 3%.1 Usually a long latent period precedes the cardinal symptoms of the disease.2 Replacement of the aortic valve is an excellent treatment for severe symptomatic aortic stenosis—symptoms improve in most patients and life expectancy approaches that of age matched controls.3 The risks of surgery are declining steadily. In patients who are having their first operation with a mechanical prosthesis and do not require a bypass graft, perioperative mortality is only 2%.4 No randomised controlled trials of aortic valve replacement in symptomatic aortic stenosis have been conducted, yet the level of evidence is regarded as class I because of the dramatic improvement in prognosis with surgery.5

In severe asymptomatic aortic stenosis the risks of perioperative morbidity, mortality, and long term complications related to the prosthesis have to be weighed against the risk of sudden cardiac death and the morbidity and mortality experienced on lengthy surgical waiting lists.6 …