Aortic stenosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Mohammed A. Sbeih, M.D. [5]

Overview

As with any surgical intervention, surgical therapies for aortic stenosis carry risks and potential for complication. These complications commonly include vascular issues such as vascular complications and mitral valve injury.

Complications

Possible complications for aortic stenosis include:

• Arrhythmias.
• Endocarditis.
• Left-sided heart failure.
• Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve.
• Atrial fibrillation.
• Myocardial infarction.
• Angina.

Complications stemming from aortic stenosis surgical therapies primarily involve vascular complications.

The most preferable surgical closure method for this tenuous patient population is a perclose or angioseal closure. This particular closure method calls for a mandatory attention to the meticulous access technique. An antegrade approach may be a viable method in some patient populations. An example of such would be the venuous access with transseptal approach. This particular procedure can be done in a select population of patients. Many patients experience an adverse response to the hemodynamic effect of mitral valve incompetence. In this situation, the rigidity of the wire traveling across the mitral valve can directly result in mitral valve injury. It is, therefore, not an advisable treatment method for most populations.

Prognosis

30% reduction in gradient is expected as the immediate result of surgical intervention. Patient survival after repeat BAV is higher than that of untreated patients.