Severe aortic stenosis: diagnosis, treatment and prognosis
Ernstige aortaklepstenose: diagnose, behandeling en prognose
Degenerative aortic stenosis is the most common valvular heart disease in developed countries. The prevalence of severe aortic stenosis increases with age from 1% in people below 65 years of age to nearly 6% in people over the age of 85. Since the population life expectancy continues to expand, severe aortic stenosis represents a growing health problem: the global annual need for aortic valve replacement (AVR) is expected to triple to approximately 850,000 by the year 2050. According to the guidelines of the American College of Cardiology (ACC), the American Heart Association (AHA) and the European Society of Cardiology (ESC) for the management of patients with valvular heart disease, symptomatic patients with severe aortic stenosis require AVR because prognosis is poor when treated conservatively: after onset of angina average life-expectancy is reported to be 4.5 years, after syncope 2.6 years and after heart failure less than one year. Besides this dismal prognosis, not much is known about the burden of disease of symptomatic patients during these final years of life. Surgical aortic valve replacement (AVR) with either a mechanical or biological prosthesis is the treatment of choice because it offers good long-term results even in elderly patients. However, up to 60% of symptomatic patients are denied AVR because of advanced age or severe co-morbidity. Furthermore, the proportion of symptomatic patients is likely to be underestimated: up to 37% of the patients who claim to be asymptomatic, experience limiting symptoms when an exercise test is performed.
|A.P. Kappetein (Arie Pieter) , J.J.M. Takkenberg (Hanneke)|
|Erasmus University Rotterdam|
|The financial support for the publication of this thesis by the following companies is gratefully acknowledged: ESJ Accountants & Belastingadviseurs Erpa B.V. specialisten in Porsche 911-912 Sorin Group Nederland N.V. Maquet Netherlands B.V. Krijnen Medical Innovations B.V. St. Jude Medical Nederland B.V. Edwards Lifesciences B.V. Takeda Nederland B.V. Johnson & Johnson Medical B.V. Thoraxcentrum Research B.V. Erasmus Medisch Centrum Stichting R&D Cardio Pulmonale Chirurgie Catharina Ziekenhuis Pa en Ma van Geldorp|
|Organisation||Erasmus MC: University Medical Center Rotterdam|
van Geldorp, M.W.A. (2013, February 20). Severe aortic stenosis: diagnosis, treatment and prognosis. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/39318