Calcific aortic stenosis: novel insights in pathophysiology, diagnosis and management

Calcfic aortic stenosis represents the most common heart valve disease in the elderly population. Recent evidence have demonstrated that active biological events lead to a progressive degeneration of aortic valve leaflets mainly regulated by lipids and inflammation. Clinical manifestation is frequently insidious at the onset and can be highly variable among patients with similar degrees of valve stenosis. The onset of symptoms represents an indication to surgical replacement. Echocardiography has become the key tool for the diagnosis and evaluation of aortic valve disease, and is the primary non-invasive imaging method for aortic valve stenosis assessment. Despite substantial contemporary experience with successful aortic valve replacement in elderly patients, multiple series have documented that 30% to 40% of patients with severe AS do not undergo surgery owing to advanced age. In summary, a substantial percentage of patients with AS are judged to be inoperable for surgery based primarily on the physician's or surgeon's determination of operative risk and survivability. Growing evidence indicate that in unoperable patients, transcatheter aortic valve implantation may represent a valid alternative to surgery with excellent results in terms of quality of life and survival.