What do we know about the natural history of severe symptomatic aortic valve stenosis?

Aortic valve stenosis (AS) is increasingly observed in the clinic. Although at present surgical valve replacement is the gold standard in patients with severe symptomatic AS, elderly patients experience higher morbidity and mortality compared with younger patients. The emergence of transcatheter aortic valve implantation offers an alternative for high-risk or inoperable patients. However, mortality and morbidity is high and long-term outcomes, particularly with respect to device durability, are not yet available. The life expectancy of patients with severe symptomatic AS who are not operated upon is reduced. Most of the reported data, however, date back to the presurgical and precatheterization era. The aim of this article is to outline the evidence of natural history with medical treatment to assist in optimal clinical decision making in the high-risk elderly population with severe symptomatic AS.