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Critical Case of Aortic Stenosis

This chapter addresses the management of aortic stenosis (AS), which affects 2%–9% of the population older than 60 years, with degenerative calcification as the most common etiology. Surgical intervention is typically unnecessary in asymptomatic patients, but severe AS warrants evaluation for treatment. Traditionally, surgical aortic valve repair was the definitive intervention. Prior to the introduction of transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty was the minimally invasive therapeutic choice for patients who could not tolerate open replacement. TAVR now provides a minimally invasive alternative which diminishes many of the risks associated with cardiopulmonary bypass while still providing a durable solution that balloon valvuloplasty does not. The chapter then looks at TAVR complications. These include cardiac arrhythmias, in some cases of which a permanent pacemaker placement is required; perivalvular leak; neurological injuries such as stroke; and vascular complications such as bleeding.