Département de cardiologie, Groupe Hospitalier Sud, Avenue René Laënnec, 80054 Amiens Cedex 1
Calcific aortic stenosis is most often degenerative and has a slow progression. Patients remain asymptomatic for a long time. Unless contraindicated, aortic valve replacement is recommended for symptomatic patients with severe aortic stenosis. Management of asymptomatic aortic stenosis is more difficult. Indeed, if a conservative approach increases the risk of sudden death which remains reasonably low in asymptomatic patients, aortic valve replacement is associated with operative mortality and risks related to the prosthesis. In a minority of asymptomatic patients, the decision to perform surgery is essentially based on the results of the exercise testing and assessment of the progression of the disease. The role of exercise echocardiography or new biomarkers such as BNP is to be determined. In the near future, percutaneous implantation of a bioprosthesis might represent an alternative option to surgery in symptomatic patients with a high operative risk.