Aortic Valvular Stenosis and Heart Failure Advances in Diagnostic, Management, and Intervention

The decision of intervention in AS patients with HF depends almost exclusively on AS-severity but in patients with HF, echocardiographic evaluation of AS-severity can be inconclusive due to discor-dant measurements, and further examination is required. When AS is determined to be severe, the choice of intervention (SAVR or TAVR) can be difficult given that patients with HF often are at intermediate-to-high operative risk, even with pre-served ejection fraction. Nevertheless, the deci-sion regarding the type of intervention should be discussed with the patient, and based on age, sur-gical risk, life expectancy, and preference of the patient. Finally, patients with HFrEF and moderate AS might benefit from intervention; however, there is no recommendation for AVR in the current guideline (except if concomitant open-heart sur-gery is planned). Ongoing studies are examining the clinical significance of AVR in patients with moderate AS and HF as well as the timing of AVR in asymptomatic patients with severe or moderate-severe AS.

Automated summary

The decision of intervention in AS patients with HF depends on the severity of AS and further examination may be required due to discordant measurements. The choice of intervention for severe AS patients with HF can be difficult due to their intermediate-to-high operative risk and should be discussed with the patient. There is no current recommendation for AVR in patients with moderate AS and HFrEF, but ongoing studies are examining its clinical significance.