Q. Management of Symptomatic Patients

All symptomatic patients with severe aortic stenosis or even moderately severe aortic stenosis should undergo aortic valve replacement and they do well after surgery. Even patients with severe LV dysfunction should be offered aortic valve replacement, if they have severe aortic stenosis.

However, if the cause for patient's left ventricular dysfunction is decreased myocardial function rather than afterload mismatch or if they do not have severe aortic stenosis they may not do well after aortic valve replacement.

Aortic valve replacement may not be indicated if the patient is very elderly, debilitated and has associated severe co morbid conditions like cancer, stroke etc. Patients with extreme degree of left ventricular hypertrophy also have increased surgical complications. In elderly patients age alone should not influence the decision regarding surgery.