Aortic Stenosis: New complexity found in an “Old Friend” The clinical challenges of correct assessment and therapy of aortic stenosis

The evolution in understanding the pathophysiology and treatment of senile calcific aortic stenosis (AS) has mirrored many other age-related conditions. The development of enhanced imaging, novel delivery systems for valve replacement and rigorous outcomes trials examining optimal choices in therapy have all contributed to enhancement in the care of those impacted by this condition. Development and analysis of experimental models providing insights into etiology have also contributed to our improved understanding. Foreseeably, these advancements have allowed identification of multiple phenotypic presentations requiring a complete understanding to optimize outcomes. These choices mandate clarity as to the benefit, risk and outcomes and at times the subtleties that each potential option delivers must be examined in order to make reasonable clinical decisions. This manuscript is a focused effort to review the state-of-the-art assessment for correct AS diagnosis, classification and therapy as it now represents one of the most rapidly changing areas encountered in clinical practice.