Challenges in Aortic Valve Stenosis: Low-Flow States Diagnosis, Management, and a Review of the Current Literature.

PURPOSE OF REVIEW: We will describe and define the current diagnosis, management, and potential therapy for low-flow aortic stenosis (AS) states, as well as summarize the available evidence underlying these recommendations.

RECENT FINDINGS: Low-flow aortic stenosis syndromes have worse prognoses than traditionally defined normal flow severe aortic stenosis. In this setting, aortic valve replacement is the only therapy that improves outcomes. Transcatheter aortic valve replacement has an ever-expanding role in the treatment of aortic stenosis, and there is growing evidence that TAVR may be a preferred therapy for low-flow AS states. Aortic stenosis remains one of the most common valvular diseases requiring therapy. Low-flow AS represents up to 40% of all patients with AS and is associated with significant mortality. This condition requires further testing for appropriate diagnosis and treatment. Low-flow AS states have poor prognoses, thus AVR and especially TAVR have a growing role in treatment of this challenging subset of AS patients.