Assessment of aortic stenosis severity: Determining timing to surgery

Abstract

“Degenerative” or calcific aortic stenosis (AS) is a complex, multi-faceted, and systemic disease that is not solely limited to the aortic valve but also includes reduced arterial compliance as well as alteration of LV geometry and function. This particular nature of the disease underlines the need for a more comprehensive assessment of AS severity going beyond the simple measurement of the conventional parameters of stenosis severity (i.e. peak aortic jet velocity, pressure gradients, valve effective orifice area) or LV function (i.e. LVEF). The present chapter thus proposes to review newer concepts to quantify the disease severity taking into account the inter-relation between the different valvular, arterial, and ventricular variables that may be responsible for the appearance of symptoms or poorer prognosis in patients with AS.