Aortic stenosis surgery overview

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Aortic stenosis surgery



Epidemiology and Demographics



Preoperative Evaluation



Outcomes and Prognosis



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]; Claudia P. Hochberg, M.D. [3]; Abdul-Rahman Arabi, M.D. [4]; Keri Shafer, M.D. [5]; Priyamvada Singh, MBBS [6]; Usama Talib, BSc, MD [7] Assistant Editor-In-Chief: Kristin Feeney, B.S. [8]


Surgical intervention may be a necessary component of treatment for symptomatic severe aortic stenosis. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis, as it improves both the symptoms and life expectancy in aortic stenosis patients, in contrast to medical therapy alone which may improve the symptoms without prolonging life expectancy. Intervention methods may include: a) Aortic valve replacement, mechanical and device based therapies such as bileaflet mechanical aortic valves; b) Aortic Balloon Valvotomy, aortic valvuloplasty (aortic valve repair).

Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure. It can be performed emergently in patients with end-stage heart failure due to aortic stenosis, patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis. Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina.

In open surgery, the surgeon makes a large cut in the sternum to reach the heart.

Minimally invasive aortic valve surgery is done through much smaller surgical cuts than the large cuts needed for open surgery.

Epidemiology and Demographics

The number of patients undergoing aortic valve replacement surgery to treat aortic stenosis has increased progressively over the past 10 years. The surgery is usually performed in elderly patients with preserved ejection fractions. Transcatheter aortic valve implantation (TAVI) represents a new option in patients with no surgical options.


Aortic stenosis requires aortic valve replacement if medical management does not successfully control symptoms. According to a prospective, single-center, nonrandomized study of 25 patients, percutaneous implantation of an aortic valve prosthesis in high risk patients with aortic stenosis results in marked hemodynamic and clinical improvement when successfully completed.[1]



The procedure can be done either by the traditional open heart surgery or by the minimally invasive surgery. Before the surgery, the patient will receive general anesthesia. This will make the patient asleep and pain-free during the entire procedure. Other than the aortic valve replacement surgery; aortic stenosis could be treated by: percutaneous aortic balloon valvotomy or transcatheter aortic valve implantation.


  1. Grube E, Laborde JC, Gerckens U; et al. (2006). "Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study". Circulation. 114 (15): 1616–24. doi:10.1161/CIRCULATIONAHA.106.639450. PMID 17015786.