Q. Management of Asymptomatic Patient?
The most common cause of death in a truly asymptomatic patient with severe aortic stenosis is aortic valve replacement (AVR). While expected incidence of sudden death in those patients is 0.4 per cent per annum, direct surgical mortality and post-operative complications are more in operated patients. However, patients with severe aortic stenosis may undergo aortic valve replacement if they are undergoing coronary artery bypass surgery, other valvular or aortic root surgery. Similarly, AVR may be done even for moderate aortic stenosis in some situations. AVR may also be considered in patients with asymptomatic severe "AS" if it is documented that they have left ventricular dysfunction or hypotensive response to exercise. It may also be considered for patients with very severe AS or excessive hypertrophy.