What is the definitive treatment for symptomatic aortic stenosis?

• A. Medical therapy
• B. Balloon valvuloplasty
• C. Beta-blockers
• D. Aortic valve replacement

Answer: (D)

Relieving the obstruction at the aortic valve is the only intervention that reliably changes the course of symptomatic severe aortic stenosis. When patients develop symptoms from a fixed, narrowed valve, medical therapies won’t reverse the stenosis or improve long-term survival, because the problem is mechanical obstruction of blood flow from the left ventricle to the aorta. Replacing the diseased valve—either through surgical aortic valve replacement or, in appropriate patients, transcatheter valve replacement—reduces afterload, improves symptoms, and has been shown to extend survival.

Balloon valvuloplasty can open the valve briefly, but the valve tends to re-narrow over time, so it isn’t considered a definitive, durable solution except as a temporary bridge to valve replacement or in patients who aren’t candidates for replacement. Beta-blockers and other medical therapies may help with certain symptoms or coexisting conditions, but they do not address the fixed obstruction and do not improve long-term outcomes in symptomatic aortic stenosis.

So, the definitive treatment is replacing the diseased aortic valve.