Table of ContentsView AllTable of ContentsFactsSymptoms (or Not)TreatmentSpecialists InvolvedTips for Caregivers
Table of ContentsView All
View All
Table of Contents
Facts
Symptoms (or Not)
Treatment
Specialists Involved
Tips for Caregivers
Aortic stenosisoccurs when theaortic valvebetween the heart’s left ventricle and the aorta narrows, restricting blood flow.Aortic stenosis can be mild, moderate, or severe, depending on the symptoms.Often, aortic stenosis causes no symptoms or only mild symptoms until it becomes severe, which is a serious condition that may involveend-of-life considerationsif surgical treatment is not an option.This article discusses end-stage aortic stenosis facts, symptoms, treatment, prognosis, and advance care planning.Halfpoint Images/ Getty ImagesAortic stenosis can becongenital, meaning you’re born with the condition. However, it most commonly occurs from calcium buildup or scarring in the aortic valve due to age.End-Stage Aortic Stenosis: The FactsThere are somefactsyou should know about end-stage aortic stenosis, such as heart damage, risk factors, and prognosis.Heart DamageIn end-stage aortic stenosis, the left ventricle has to work harder to pump blood because the aortic valve is narrowed. This can cause the left ventricle wall to thicken, affecting the heart’s ability to supply blood to the rest of the body.Without treatment, aortic stenosis can lead toheart failure, a severe condition in which the heart doesn’t pump well enough to supply the body with enough blood and oxygen.Risk GroupsAortic stenosis is a progressive condition, but the reasons it progresses are mainly unknown.Risk factors that can be associated with quicker progression or aortic stenosis include:Advanced ageBody mass index (BMI)Tobacco useHigh blood pressure (hypertension)High cholesterolMetabolic syndrome(a combination of conditions that can increase the risk of heart disease, stroke, and type 2 diabetes)Prognosis at DiagnosisWithout valve replacement surgery, end-stage aortic stenosis without symptoms (asymptomatic) has a poor long-term survival rate similar to that of some cancers. The one-year survival rate in patients younger than 70 years old with severe aortic stenosis without symptoms is 46% at three years and 37% at four years. The four-year survival rate in patients over 70 years old with severe aortic stenosis without symptoms is 16%.The average life expectancy for aortic stenosis with symptoms (such as shortness of breath or chest pain) is one to two years without treatment. About one-third of patients with aortic stenosis do not receive valve replacement surgery, which is the only effective treatment for the condition.Symptoms (or No Symptoms) of End-Stage Aortic StenosisAortic stenosis creates a uniqueheart murmurthat changes as the disease progresses. The murmur can typically be heard when a healthcare provider listens to the heart with a stethoscope during a physical exam.About one-fourth of patients with severe aortic stenosis don’t have anysymptoms. However, symptoms might be underreported in older adult patients because of other conditions they may have, such as memory issues,degenerative arthritis, and poor mobility.Severe aortic stenosis can occur without symptoms for years. Unless treated with valve replacement surgery, the likelihood of having no symptoms from severe aortic stenosis is 82% after one year, 67% after two years, and 33% after five years.Symptoms of aortic stenosis often don’t occur until there is severe damage to the heart valve. Symptoms of end-stage aortic stenosis include:Chest painortightnessRapid or fluttering heartbeatShortness of breathDizziness or faintnessIncreased exhaustion after activitySwollen anklesand feetDifficulty sleepingTreatment During End-Stage Aortic StenosisValve replacementsurgery is the only treatment that can improve survival and quality of life in those with end-stage aortic stenosis.It is performed through open-heart surgical aortic valve replacement surgery (SAVR) or minimally invasivetranscatheter aortic valve replacement(TAVR).With TAVR, a new valve is placed inside the diseased valve through a catheter. The procedure has fewer risks and a quicker recovery time thanopen heartvalve replacement surgery.TAVR was first performed only in those with aortic stenosis who were too high risk for open heart surgery, but it is now performed in lower-risk patients as well.Older patients who are frail or have other conditions such as lung disease, coronary artery disease, or renal (kidney) dysfunction might not be candidates for valve replacement surgery. In these cases,palliative care(specialized care aimed at relieving symptoms) can be used alongside medications and other methods to reduce symptoms and improve quality of life.Specialists Involved and HospitalizationIf you have end-stage aortic stenosis, your care team will usually include:A primary care physicianA generalcardiologist(heart doctor)A cardiac sonographer (a specialist who takesultrasound imagesof the heart)If you have valve replacement surgery, it will be performed in a hospital. There, specialists who treat you can include:An interventional cardiologist or cardiothoracic surgeonA valve clinic coordinator to help you navigate treatmentA cardiovascularanesthesiologist(gives anesthetic medicines during heart surgery)Cardiovascular nursesTips for CaregiversOne of the challenges in managing end-stage aortic stenosis is ensuring that medical treatment is balanced with supportive care.At the time of diagnosis of end-stage aortic stenosis,advance care planningand palliative care should be discussed. Even if a patient is a candidate for valve replacement surgery, it’s possible the surgery will not go as planned or have complications.Palliative care isspecialized carethat can play an essential role in patients with end-stage aortic stenosis at the time of diagnosis and throughout the disease. Advance care planning and palliative care can help:Reduce caregiver and patient anxietyManage patient symptomsHelp caregivers follow patient wishesImprove communication between patients, caregivers, and familiesProvide psychosocial, spiritual, and bereavement supportSummaryBecause aortic stenosis often doesn’t have symptoms, especially in its early stages, you might not know you have the condition until it’s severe. End-stage aortic stenosis can cause serious heart damage and has a limited life expectancy unless valve replacement surgery is performed. Advance care planning should be discussed to benefit the patient and caregivers when end-stage aortic stenosis is diagnosed.
Aortic stenosisoccurs when theaortic valvebetween the heart’s left ventricle and the aorta narrows, restricting blood flow.Aortic stenosis can be mild, moderate, or severe, depending on the symptoms.
Often, aortic stenosis causes no symptoms or only mild symptoms until it becomes severe, which is a serious condition that may involveend-of-life considerationsif surgical treatment is not an option.
This article discusses end-stage aortic stenosis facts, symptoms, treatment, prognosis, and advance care planning.
Halfpoint Images/ Getty Images
Aortic stenosis can becongenital, meaning you’re born with the condition. However, it most commonly occurs from calcium buildup or scarring in the aortic valve due to age.
End-Stage Aortic Stenosis: The Facts
There are somefactsyou should know about end-stage aortic stenosis, such as heart damage, risk factors, and prognosis.
Heart Damage
In end-stage aortic stenosis, the left ventricle has to work harder to pump blood because the aortic valve is narrowed. This can cause the left ventricle wall to thicken, affecting the heart’s ability to supply blood to the rest of the body.
Without treatment, aortic stenosis can lead toheart failure, a severe condition in which the heart doesn’t pump well enough to supply the body with enough blood and oxygen.
Risk Groups
Aortic stenosis is a progressive condition, but the reasons it progresses are mainly unknown.Risk factors that can be associated with quicker progression or aortic stenosis include:
Prognosis at Diagnosis
Without valve replacement surgery, end-stage aortic stenosis without symptoms (asymptomatic) has a poor long-term survival rate similar to that of some cancers. The one-year survival rate in patients younger than 70 years old with severe aortic stenosis without symptoms is 46% at three years and 37% at four years. The four-year survival rate in patients over 70 years old with severe aortic stenosis without symptoms is 16%.
The average life expectancy for aortic stenosis with symptoms (such as shortness of breath or chest pain) is one to two years without treatment. About one-third of patients with aortic stenosis do not receive valve replacement surgery, which is the only effective treatment for the condition.
Symptoms (or No Symptoms) of End-Stage Aortic Stenosis
Aortic stenosis creates a uniqueheart murmurthat changes as the disease progresses. The murmur can typically be heard when a healthcare provider listens to the heart with a stethoscope during a physical exam.
About one-fourth of patients with severe aortic stenosis don’t have anysymptoms. However, symptoms might be underreported in older adult patients because of other conditions they may have, such as memory issues,degenerative arthritis, and poor mobility.
Severe aortic stenosis can occur without symptoms for years. Unless treated with valve replacement surgery, the likelihood of having no symptoms from severe aortic stenosis is 82% after one year, 67% after two years, and 33% after five years.
Symptoms of aortic stenosis often don’t occur until there is severe damage to the heart valve. Symptoms of end-stage aortic stenosis include:
Treatment During End-Stage Aortic Stenosis
Valve replacementsurgery is the only treatment that can improve survival and quality of life in those with end-stage aortic stenosis.It is performed through open-heart surgical aortic valve replacement surgery (SAVR) or minimally invasivetranscatheter aortic valve replacement(TAVR).
With TAVR, a new valve is placed inside the diseased valve through a catheter. The procedure has fewer risks and a quicker recovery time thanopen heartvalve replacement surgery.TAVR was first performed only in those with aortic stenosis who were too high risk for open heart surgery, but it is now performed in lower-risk patients as well.
Older patients who are frail or have other conditions such as lung disease, coronary artery disease, or renal (kidney) dysfunction might not be candidates for valve replacement surgery. In these cases,palliative care(specialized care aimed at relieving symptoms) can be used alongside medications and other methods to reduce symptoms and improve quality of life.
Specialists Involved and Hospitalization
If you have end-stage aortic stenosis, your care team will usually include:
If you have valve replacement surgery, it will be performed in a hospital. There, specialists who treat you can include:
One of the challenges in managing end-stage aortic stenosis is ensuring that medical treatment is balanced with supportive care.
At the time of diagnosis of end-stage aortic stenosis,advance care planningand palliative care should be discussed. Even if a patient is a candidate for valve replacement surgery, it’s possible the surgery will not go as planned or have complications.
Palliative care isspecialized carethat can play an essential role in patients with end-stage aortic stenosis at the time of diagnosis and throughout the disease. Advance care planning and palliative care can help:
Summary
Because aortic stenosis often doesn’t have symptoms, especially in its early stages, you might not know you have the condition until it’s severe. End-stage aortic stenosis can cause serious heart damage and has a limited life expectancy unless valve replacement surgery is performed. Advance care planning should be discussed to benefit the patient and caregivers when end-stage aortic stenosis is diagnosed.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UNC School of Medicine.Aortic valve disease.American Heart Association.Managing aortic stenosis symptoms.American Heart Association.Aortic stenosis overview.American Heart Association.What is heart failure?Willner, N, Prosperi-Porta, G, Lau, L. et al.Aortic stenosis progression: a systematic review and meta-analysis.J Am Coll Cardiol Img.2023 Mar, 16 (3) 314–328. doi:10.1016/j.jcmg.2022.10.009Penn Medicine.Aortic valve stenosis.Senguttuvan NB, Srinivasan NV, Panchanatham M, et al.Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function.Open Heart. 2024 Jan 8;11(1):e002511. doi:10.1136/openhrt-2023-002511Healio Learn the Heart.Aortic stenosis-physical exam.Paek M, Rinderle T, Resnick R, Bekelman DB.Palliative care issues in aortic stenosis.Journal of Palliative Medicine. 2023;26(11):1578-1580. doi:10.1089/jpm.2023.0388Lauck SB, Gibson JA, Baumbusch J, et al.Transition to palliative care when transcatheter aortic valve implantation is not an option: opportunities and recommendations.Curr Opin Support Palliat Care.2016 Mar;10(1):18-23. doi:10.1097/SPC.0000000000000180American Heart Association.What is TAVR?Steiner JM, Cooper S, Kirkpatrick JN.Palliative care in end-stage valvular heart disease.Heart.2017 Aug;103(16):1233-1237. doi:10.1136/heartjnl-2016-310538American Heart Association.Your aortic stenosis care team.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UNC School of Medicine.Aortic valve disease.American Heart Association.Managing aortic stenosis symptoms.American Heart Association.Aortic stenosis overview.American Heart Association.What is heart failure?Willner, N, Prosperi-Porta, G, Lau, L. et al.Aortic stenosis progression: a systematic review and meta-analysis.J Am Coll Cardiol Img.2023 Mar, 16 (3) 314–328. doi:10.1016/j.jcmg.2022.10.009Penn Medicine.Aortic valve stenosis.Senguttuvan NB, Srinivasan NV, Panchanatham M, et al.Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function.Open Heart. 2024 Jan 8;11(1):e002511. doi:10.1136/openhrt-2023-002511Healio Learn the Heart.Aortic stenosis-physical exam.Paek M, Rinderle T, Resnick R, Bekelman DB.Palliative care issues in aortic stenosis.Journal of Palliative Medicine. 2023;26(11):1578-1580. doi:10.1089/jpm.2023.0388Lauck SB, Gibson JA, Baumbusch J, et al.Transition to palliative care when transcatheter aortic valve implantation is not an option: opportunities and recommendations.Curr Opin Support Palliat Care.2016 Mar;10(1):18-23. doi:10.1097/SPC.0000000000000180American Heart Association.What is TAVR?Steiner JM, Cooper S, Kirkpatrick JN.Palliative care in end-stage valvular heart disease.Heart.2017 Aug;103(16):1233-1237. doi:10.1136/heartjnl-2016-310538American Heart Association.Your aortic stenosis care team.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
UNC School of Medicine.Aortic valve disease.American Heart Association.Managing aortic stenosis symptoms.American Heart Association.Aortic stenosis overview.American Heart Association.What is heart failure?Willner, N, Prosperi-Porta, G, Lau, L. et al.Aortic stenosis progression: a systematic review and meta-analysis.J Am Coll Cardiol Img.2023 Mar, 16 (3) 314–328. doi:10.1016/j.jcmg.2022.10.009Penn Medicine.Aortic valve stenosis.Senguttuvan NB, Srinivasan NV, Panchanatham M, et al.Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function.Open Heart. 2024 Jan 8;11(1):e002511. doi:10.1136/openhrt-2023-002511Healio Learn the Heart.Aortic stenosis-physical exam.Paek M, Rinderle T, Resnick R, Bekelman DB.Palliative care issues in aortic stenosis.Journal of Palliative Medicine. 2023;26(11):1578-1580. doi:10.1089/jpm.2023.0388Lauck SB, Gibson JA, Baumbusch J, et al.Transition to palliative care when transcatheter aortic valve implantation is not an option: opportunities and recommendations.Curr Opin Support Palliat Care.2016 Mar;10(1):18-23. doi:10.1097/SPC.0000000000000180American Heart Association.What is TAVR?Steiner JM, Cooper S, Kirkpatrick JN.Palliative care in end-stage valvular heart disease.Heart.2017 Aug;103(16):1233-1237. doi:10.1136/heartjnl-2016-310538American Heart Association.Your aortic stenosis care team.
UNC School of Medicine.Aortic valve disease.
American Heart Association.Managing aortic stenosis symptoms.
American Heart Association.Aortic stenosis overview.
American Heart Association.What is heart failure?
Willner, N, Prosperi-Porta, G, Lau, L. et al.Aortic stenosis progression: a systematic review and meta-analysis.J Am Coll Cardiol Img.2023 Mar, 16 (3) 314–328. doi:10.1016/j.jcmg.2022.10.009
Penn Medicine.Aortic valve stenosis.
Senguttuvan NB, Srinivasan NV, Panchanatham M, et al.Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function.Open Heart. 2024 Jan 8;11(1):e002511. doi:10.1136/openhrt-2023-002511
Healio Learn the Heart.Aortic stenosis-physical exam.
Paek M, Rinderle T, Resnick R, Bekelman DB.Palliative care issues in aortic stenosis.Journal of Palliative Medicine. 2023;26(11):1578-1580. doi:10.1089/jpm.2023.0388
Lauck SB, Gibson JA, Baumbusch J, et al.Transition to palliative care when transcatheter aortic valve implantation is not an option: opportunities and recommendations.Curr Opin Support Palliat Care.2016 Mar;10(1):18-23. doi:10.1097/SPC.0000000000000180
American Heart Association.What is TAVR?
Steiner JM, Cooper S, Kirkpatrick JN.Palliative care in end-stage valvular heart disease.Heart.2017 Aug;103(16):1233-1237. doi:10.1136/heartjnl-2016-310538
American Heart Association.Your aortic stenosis care team.
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