The enthralling complexity of aortic stenosis

Much is written about the preoperative assessment of aortic valve stenosis. The focus mainly is on identifying features that are associated with a poor short-term outcome, namely death, in the absence of intervention. The most important features are onset of symptoms, the peak trans-aortic velocity and the aortic valve area. This is reflected in the guidelines, and we use these parameters on a daily basis. Indeed, we often use only these parameters, but we appreciate that they are relatively crude. The assessment of aortic stenosis is much more nuanced. There is increasing evidence for the role of additional parameters, be they echocardiographic, demographic, or biochemical. Incremental information can be obtained from parameters such as right ventricular (RV) systolic pressure, RV function, left atrial volume index, aortic valve area index, valvulo-arterial impedence, circumferential strain, gender, ethnicity, troponin value and NT-pro BNP value.1–4 Undoubtedly, there are many more. The common theme however, is that these features identify those whose short-term outcome is poor without intervention. Identifying those whose short-term outcome is poor is not the same as identifying those who will do well postoperatively. It does not directly follow …