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Back to Basics: Aortic Stenosis

Jordan Roberts, PA-C
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Aortic stenosis is a common,acquired valvular disease characterized by dyspnea, angina and fatigue. Evaluation includes history, physical exam, and echocardiogram. Surgery is indicate for severe disease and symptomatic patients.


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Danielle K. -

Anyone know if there is anyone out there investigating surgery before progression to severe AS? Asking due to a lot of the time patients requiring surgery are elderly and have a TON of co-morbidities and sometimes are not great surgical candidates due age and other risk factors they become considered "high risk for a high risk procedure". Obviously this does not go with current guidelines, but wondering if there is any research or trains of thoughts about this out there?

Heidi J., MD -

Hi Danielle: Here's Jordan Roberts' reply -

As for what sounds a lot like 'prophylactic' AV surgery for calcific AS, it's my understanding that the risks really outweigh the benefits, as asymptomatic patients can do quite well for a long time, and because once you start opening up their thoracic cavity, the chances of things going wrong predictably increases. Another potential limitation is that in order to study a prophylactic AVR, you'd have to expose a bunch of otherwise 'low-risk' aortic stenosis patients to this high risk procedure, all in an effort to protect the relatively few patients who are otherwise too sick to cut on (the definition you and I would use for 'too sick' I'm sure varies greatly from that of a CT surgeon). However, we now have the famous transcatheter AVR (TAVR), which is generally recommended for those really sick patients with a slew of co-morbidities and severe, symptomatic AS, especially when they are not traditional surgical candidates or who are otherwise 'inoperable.' Of course, if their co-morbidities are likely to catch up to them in the next 12 mo, there isn't really much benefit of replacing of fixing the valve either way, at least according to the ACC 2014 guidelines (same reference as the segment). Let me know if you have any other questions!

Danielle K. -

PS love that you guys added a PA-C to your staff!

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Sweat Puddled, Brains Muddled Full episode audio for MD edition 173:58 min - 82 MB - M4AHippo Primary Care RAP February 2017 Summary 316 KB - PDF