Section 1 Aortic Valve Disease

**3**

**Chapter 1**

Perspective

**1. Introduction**

**2. Background**

and comorbidities [1].

population is less than 50% at two years [2].

Introductory Chapter: The

Pathology - The Surgeon's

*Michael S. Firstenberg and Jennifer Hanna*

disease both at a patient as well as a population level.

Evolution of Complex Valve

The management of aortic valve disease has undergone a dramatic transformation over the past 10 years. Without a doubt there has been significant developments in the diagnostic and management tools available to assess patients with aortic valve pathology. In addition to these tools are better and safer surgical techniques, especially with regards to anesthesia, myocardial protection, and peri-operative care, as well as the means in which patients can be risk-assessed to help guide decisionmaking. However, despite these advances, patients presenting with significant valvular disease are getting older and often will have substantial and more complex co-morbidities that place them at significant risk for challenging short- and longterm adverse outcomes. The goal of this text is to illustrate some of the challenges and controversies, with an emphasis on a surgical perspective, regarding the diagnosis and management of one of the most common forms of degenerative valve disease – aortic stenosis. While, by no means, is this a comprehensive review, it does provide a foundation and potential paradigm for how we evaluate, manage, and study valve

Aortic stenosis is the most prevalent form of native valvular disease. Significant stenosis, as determined by the gradients across the valve and estimated orifice areas, are encountered in up to 2% of the population over 65 years old, 3% in those over 75 years old and 4% over 85 years old. Furthermore, over 100,000 people in the United States alone are diagnosed with severe aortic stenosis each year. Historically, the management of severe and critical aortic stenosis, especially in the context of symptoms such as chest pain, syncope, and shortness of breath, has focused on surgical intervention. However, the risks increase substantially with patients age

Typically, severe or critical stenosis is manifested with the onset of symptoms such as shortness of breath. However, when patients start developing heart failure, chest pain, or syncope, their prognosis becomes worse than many cancers, including breast and colon. In fact, without intervention, the estimated survival in this
