Severe Symptomatic Aortic Stenosis in Older Adults Pathophysiology, Clinical Manifestations, Treatment Guidelines, and Transcatheter Aortic Valve Replacement (TAVR)

摘要

The only effective treatment for symptomatic aortic stenosis in the older adult population is surgical aortic valve replacement. However, more than 30% of candidates are denied surgery due to advanced age and multiple comorbidities. Without surgical intervention, death from symptomatic aortic stenosis approximates 2% per month, with mortality rates of approximately 50% within 2 years of symptom onset. There is no effective medical treatment for severe symptomatic aortic stenosis; care has been limited to palliative remedies and end-of-life decisions. Nascent advances in miniaturization and catheter technologies provide a new and less invasive approach: transcatheter aortic valve replacement (TAVR). The current article summarizes treatment guidelines; pathophysiology; clinical manifestations, progression, and classification of severe symptomatic aortic stenosis; and introduces TAVR and discusses randomized controlled trials involving three patient populations from the United States, with relevant nursing implications.