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Editorial comment

Therapeutic decisions for patients with symptomatic severe aortic stenosis Much still to do!

Department of Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal

^_* Corresponding author. Tel.: +351 239 400418; fax: +351 239 829674. (Email: antunes.cct.huc@sapo.pt).

Key Words: Epidemiology • Aortic stenosis • Aortic valve replacement • Percutaneous aortic valve implantation

The first 20% of the full text of this article appears below.

In a paper published in this issue of the Journal, van Geldorp and co-workers from Rotterdam, discuss the therapeutic decisions for patients with symptomatic severe aortic stenosis (AS) [1]. Since the publication of the results of the valve subgroup of pathologies of the EuroHeart Survey, by Iung and co-workers [2,3], indicating that surgery was denied in 33% of elderly patients with severe, symptomatic AS, this has been used as the most important motivation for percutaneous aortic valve implantation (PAVI), which has since known rapid development and expansion, both in Europe and in America.

But, although the early results of PAVI have been encouraging, especially when applied to elderly patients who are extremely high risk for surgery, its application to intermediate risk patients raises many questions as the short-term results are not yet comparable to those obtained by surgical replacement of the aortic valve, which is here to stay [4]. Besides, the medium- and long-term results of PAVI are yet unknown. Conversely, interest in aortic stenosis has been renewed and many works on the prognosis and on medical and surgical therapeutic options for this pathology, showing improved outcome, were published in the past couple of years.

It is, thus, important to analyse the reasons why so many patients are denied surgery. When the results of the EuroHeart Survey were released, many surgeons, including myself, questioned their value and applicability . . . [Full Text of this Article]

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