Patients with symptomatic severe valvular AS have a POOR PROGNOSIS WITHOUT VALVE REPLACEMENT.
The average survival rate was 3 years after the onset of angina pectoris in patients with severe Aortic Stenosis (AS). The average survival rate after the onset of syncope in patients with severe AS ISs 3 years. The average survival rate after the onset of heart failure in patients with severe AS was 1.5 to 2 years. Surgical Aortic Valve Replacement (AVR) is the procedure of choice for symptomatic patients with severe AS (an aortic valve area less than 1.0 cm2) with a Class I indication.
In a prospective study, at 19-month follow-up (range 2 to 36 months), 90% of 30 patients with heart failure associated with unoperated severe AS and a normal left ventricular ejection fraction were dead [3]. At 13-month follow-up (range 2 to 24 months), 100% of 18 patients with heart failure associated with unoperated severe AS and an abnormal left ventricular ejection fraction were dead. In a prospective study, at 20-month follow-up of 40 elderly patients with severe AS, heart failure, syncope, or angina pectoris was present in 36 of 37 patients (97%) who developed new coronary events and in none of 3 patients (0%) without new coronary events [4].
Other Class I indications for AVR in patients with severe AS include patients undergoing coronary artery bypass graft surgery, patients undergoing surgery on the aorta or other heart valves, and patients with a left ventricular ejection fraction less than 50%. Patients with moderate AS undergoing coronary artery bypass graft surgery or surgery on the aorta or other heart valves have a Class IIa indication for AVR.
