Management of Aortic Stenosis and Chronic Heart Failure: A Clinical Consensus Statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

Aortic stenosis (AS) is common and can cause heart failure (HF) or contribute to the progression of pre-existing HF. The management of patients with concomitant AS and HF poses specific clinical challenges. Optimization of guideline-directed medical therapy for HF may be difficult in patients with AS, especially in case of reduced left ventricular ejection fraction. Transcatheter or surgical aortic valve replacement (AVR) is the evidence-based treatment of choice for patients with severe AS and HF. However, advanced cardiac damage, concomitant conditions that can cause HF in addition to AS, as well as some procedure-related factors, may contribute to persistence or worsening of HF after AVR. A multidisciplinary management involving an HF specialist is crucial in this setting and should include a dedicated pre-procedural HF and AS assessment, as well as a careful post-procedural follow-up, including monitoring of HF status. The aim of this clinical consensus statement is to summarize current knowledge on AS and HF, with a focus on pre-procedural and post-procedural management of patients with HF undergoing AVR.