cardiovascular disorders
Aortic Stenosis
Prognosis for Aortic Stenosis
Aortic stenosis progresses faster as severity increases, but the wide variability in progression rates requires regular surveillance, particularly in sedentary older patients. In such patients, flow may become significantly compromised without triggering symptoms. Asymptomatic patients with severe AS and normal systolic function should be reevaluated every 6 months because 3 to 6% will develop symptoms of LVEF impairment every year. The risk of surgery outweighs the survival benefit in asymptomatic patients, but with the onset of symptoms the mean survival plummets to 2 to 3 years, and prompt valve replacement is indicated to relieve symptoms and improve survival. Risk of surgery increases for patients who require simultaneous CABG and for those with depressed systolic LV function. In patients with severe AS, about 50% of deaths occur suddenly, and these patients should be advised to limit physical exertion. 