Aortic valve stenosis is a condition in which the aortic valve narrows, restricting blood flow from the heart. The most common causes and risk factors include:
The condition often progresses slowly, but there is wide individual variation in the rate of progression.
Many people have few or no symptoms for years, especially if the narrowing is mild. However, as the valve becomes more narrowed, symptoms can occur. Telltale signs and symptoms include:
If you experience any or all of these symptoms or are concerned about them, do not hesitate to seek a professional medical evaluation. Even if you have few or no symptoms, a severely narrowed aortic valve can become life-threatening, so it is important to undergo regular cardiac tests.
Your doctor may be able to detect aortic valve stenosis based on the typical sound of the heart murmur that can arise from the condition. The main diagnostic test is the transthoracic echocardiogram – also known as a TTE – which is a procedure that uses ultrasound to visualize the heart.
An echocardiogram can confirm the diagnosis by detecting:
In addition to an echocardiogram, your doctor may recommend other tests, such as CT scanning, transoesophageal echocardiogram, stress testing or cardiac catheterization, if you have additional symptoms that require further evaluation or if the initial tests are inconclusive.
According to the latest European guidelines, the diagnosis requires an integrated assessment of the valve area, pressure gradients, blood flow across the valve, calcification of the valve and the function of the left ventricle.
The decision to treat is based primarily on the severity of the disease and the impact it has on the individual. In other words, it depends on more than just one factor. The following general treatment guidelines may apply:
Mild disease without relevant symptoms - Regular monitoring and follow-up with a cardiologist is recommended. Severe disease in individuals with symptoms - Consider treatment based on Heart Team discussion. Severe disease in individuals with reduced heart function - Treatment is generally indicated.
Drugs can help to control symptoms and other associated conditions, but they cannot remove or widen the narrowed aortic valve. Thus, they are generally ineffective in severe form requiring intervention. In addition to drugs, people with severe form and relevant symptoms should consider treatment options, for example, surgery, to replace the faulty aortic valve. The most appropriate treatment is – either aortic valve replacement surgery or transcatheter aortic valve replacement (TAVR) – will depend on a number of factors.
The TAVR procedure is a type of keyhole surgery that treats severe aortic stenosis by replacing the faulty aortic valve with a new biological prosthetic valve. The main advantage is that it generally has a faster recovery compared to open-heart surgery. It allows people who are at increased surgical risk to benefit from aortic valve replacement surgery.
The replacement valve is inserted into the aorta using a catheter that is guided through the femoral artery – that is, the large blood vessel in the groin. Other access sites can also be used in certain cases. Once the new valve reaches the heart, it is deployed to open up the narrowed aortic valve and begin regulating blood flow.
When deciding whether to use a catheter-based procedure or conventional open-heart surgery to replace the aortic valve, the cardiologist takes many factors into account, including age, symptoms and risk of the procedure, and considers alternative treatments if they exist. The choice between surgical and transcatheter aortic valve replacement is made by the medical team.
According to the latest ESC/EACTS guidelines, transcatheter aortic valve implantation (TAVI) is indicated in appropriately selected patients with tricuspid aortic valve stenosis aged 70 years or older, whereas surgical aortic valve replacement (SAVR) is recommended for most patients under 70 years of age with low surgical risk.
Transcatheter aortic valve replacement is a minimally invasive procedure that does not require opening up the chest. Instead, the new valve is inserted through a catheter that is guided through blood vessels to the heart. On the other hand, open-heart surgery requires a surgeon to make an incision in the chest to gain access to the heart.
For people with aortic valve stenosis, both transcatheter and surgical aortic valve replacement are effective treatment options, but each one has particular advantages and disadvantages, and thus the choice between the two is carefully individualized based on various criteria.
People who are considering aortic valve replacement – whether surgical or transcatheter – should ideally be evaluated in a centre equipped with expertise in both interventions. According to the 2025 European guidelines, treatment for severe aortic stenosis should be provided in Heart Valve Centers with interventional cardiology and cardiac surgery expertise.
Aortic stenosis often presents with few or no symptoms early on but can severely restrict blood flow and put strain on the heart as the disease progresses. It is therefore important to pay attention to any signs or symptoms that may indicate the condition and schedule an echocardiogram. Once the disease reaches an advanced stage, there are two proven treatments that can be discussed with the Heart Team.
If you or a family member has been diagnosed, it is important to consult a cardiologist for an echocardiogram and treatment rather than wait for symptoms to become severe.
Q1: Can aortic valve stenosis be cured?
A: It is a progressive disease and thus it cannot be cured. However, various treatments are available to slow the progression of the disease and manage its symptoms.
Q2: Can patients be treated with drugs?
A: It cannot be cured with drugs. However, in many cases, medications can help to manage some of the symptoms and conditions associated with the disease.
Q3: Is TAVR surgery the same as open-heart valve surgery?
A: No, it is a procedure in which a catheter is used to deliver a new valve directly to the heart. On the other hand, open-heart surgery to replace the aortic valve requires an incision in the chest.
Q4: How long can a person with untreated severe aortic stenosis live?
A: This depends on several factors, including the severity of the valve stenosis, the presence of symptoms, heart function and other conditions. Severe form is a potentially life-threatening condition, but it can often be treated successfully. Even so, patients with severe form should always see a cardiac specialist if left untreated, because they may develop dangerous complications.
Q5: Can every patient with severe aortic valve stenosis be treated with TAVR?
A: No, treatment with TAVR is indicated for appropriately selected patients. Several factors, including anatomical characteristics of the heart, age, surgical risk, vascular access options and other considerations, must be taken into account.
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