Aortic Valvular Disease

Introduction

Surgery to repair a dysfunctional aortic valve remains the most common indication for valvular heart surgery. Broadly speaking, pathology is categorized as being primarily related to valvular stenosis (AS) or regurgitation (AR), but a diseased valve may often exhibit both. The predilection of degenerative disease of the aortic valve, particularly stenosis, for the elderly has resulted in a steadily increasing prevalence as the population ages. As general life expectancy increases in the United States and other western countries, surgery to correct aortic valve disease will increase. As more elderly patients with more comorbidities present for surgery their intraoperative and perioperative care will become more complex.

In general, symptomatic patients should be offered surgical correction. However, many elderly patients with severe AS have significant medical comorbidities. In the past, this has resulted in a significant minority of patients not being referred for surgery. The advent of transcatheter aortic valve replacement (TAVR) has offered promise as a durable therapeutic option for those patients previously considered to be at increased risk for traditional surgery.

The goal of this chapter to is to provide an overview of the epidemiology and pathophysiology of adult aortic valve disease followed by a discussion of the operative procedures performed to correct this pathology. Emphasis will be placed on potential complications and their manifestations in the immediate peri-operative period to facilitate identification and treatment for the practicing intensivist.