What can happen if I do nothing for my aortic stenosis?

Typically, aortic stenosis (AS) is a progressive disease. The cross-section of a normal aortic valve is about the size of nickel (3 to 4 cm2). In aortic stenosis, this cross-section becomes smaller. As aortic stenosis progresses, the left ventricle, the main pumping chamber of the heart, must compensate by increasing the pressure it must generate to eject the same amount of blood through the smaller valve. When the aortic valve area decreases to 1 cm2 or less (about the size of the head of a golf tee), changes in the ventricle may no longer be adequate to overcome the outflow obstruction. This can lead to heart failure, syncope (loss of consciousness) and/or angina (chest pain).

If untreated, the interval from onset of symptoms to death varies:

• 2 years for heart failure
• 3 years for syncope
• 5 years for angina

There is no medical treatment to reverse aortic stenosis. In advanced stages, surgery is required to correct this problem. Surgical treatment is indicated in patients with:

• Severe aortic stenosis and symptoms or those undergoing other cardiac surgery
• Severe aortic stenosis with heart dysfunction, defined by an ejection fraction < 50 percent
• Severe or moderate aortic stenosis undergoing cardiac surgery for coronary or other valvular heart disease

If you do nothing for your aortic stenosis, it is important to know that severe aortic stenosis, even when there are no symptoms, carries a poor outcome if left untreated. For people with aortic stenosis, undergoing aortic valve replacement (AVR) is associated with significantly higher overall survival.

Survival in people with aortic stenosis depends on the type of symptoms they have. In people with chest pain, the average survival rate is about five years. If the person is passing out (syncope), the survival rate drops to three years. The average survival rate of people with congestive heart failure is two years. Research shows that severe inoperable aortic stenosis has the worst rate of survival. It’s something people need to be aware of, catch early and have diagnosed appropriately. It is estimated that the average survival rate in elderly people is about one year.