Moderate aortic stenosis: culprit or bystander?

Moderate aortic stenosis: culprit or bystander?
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DOI:
10.1136/openhrt-2021-001743
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发表时间:
2022-01
期刊:
影响因子:
2.7
通讯作者:
Strom JB
Strom JB
中科院分区:
其他
文献类型:
--
作者:
Pankayatselvan V;Raber I;Playford D;Stewart S;Strange G;Strom JB

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非风湿性主动脉瓣狭窄(AS)是发达国家最常见的瓣膜疾病之一。目前的指南支持对严重症状性 AS 进行主动脉瓣置换术 (AVR),如果不治疗,该病的发病率和死亡率很高。相比之下,中度 AS 历来被认为是良性诊断,AVR 的潜在益处超过了手术风险。然而,新出现的数据表明,未经治疗的中度强直性脊柱炎存在显着的死亡风险,并且 AVR 可以显着改善围手术期和围手术期死亡率,这对传统的风险/效益范式提出了挑战。因此,有必要对与中度 AS 相关的发病率和死亡率的当代数据以及 AS 瓣膜介入治疗的适当时机进行评估。在这篇综述中,我们讨论了目前对中度 AS 的理解,包括流行病学、当前的监测和管理指南、临床结果和未来的研究。
Non-rheumatic aortic stenosis (AS) is among the most common valvular diseases in the developed world. Current guidelines support aortic valve replacement (AVR) for severe symptomatic AS, which carries high morbidity and mortality when left untreated. In contrast, moderate AS has historically been thought to be a benign diagnosis for which the potential benefits of AVR are outweighed by the procedural risks. However, emerging data demonstrating the substantial mortality risk in untreated moderate AS and substantial improvements in periprocedural and perioperative mortality with AVR have challenged the traditional risk/benefit paradigm. As such, an appraisal of the contemporary data on morbidity and mortality associated with moderate AS and appropriate timing of valvular intervention in AS is warranted. In this review, we discuss the current understanding of moderate AS, including the epidemiology, current surveillance and management guidelines, clinical outcomes, and future studies.
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