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The Treatment of Aortic Valve Stenosis in Patients at Intermediate-High Risk

Paolo Nardi, Marco Russo, Guglielmo Saitto and Giovanni Ruvolo

Aortic valve stenosis (AS) is the most common valvular pathology in the elderly with an estimated prevalence of 4.6% in patients older than 75 years. Most of the patients remain asymptomatic for decades and when they develop symptoms, the prognosis became drastically poor with an estimated mortality of 50% in two years without surgical treatment. Aortic valve replacement (AVR) represents the gold standard for treatment of patients affected by aortic valve stenosis. Introduced in 1960s, AVR is associated with excellent long-term outcomes and low perioperative mortality and morbidity. With the aging of population, number of patients with AS increased progressively and the typical patient's profile has become more and more complex with more associated pathology and higher surgical risk. In this complex scenario the introduction of transcatheter aortic valve implantation (TAVI) has profoundly altered the landscape of cardiovascular medicine.