Treatment of Aortic Valve Stenosis Beyond Valve Replacement - What Does the Future Hold?

Calcifying aortic valve stenosis is the most common heart valve disease requiring interventional or surgical treatment in adults and particularly affects older people. Although progress in interventional therapeutic options has improved the treatment of aortic valve stenosis in recent years, symptomatic aortic valve stenosis is still associated with high morbidity and mortality. Its pathophysiology is characterized by fibrosis and calcification of the valvular cusps, leading to progressive thickening and stiffening of the cusp tissue, and ultimately obstruction of the valve with impaired blood flow through the valve. Since those affected are usually of advanced age and have other important comorbidities, surgical or interventional replacement of the aortic valve is associated with a higher risk and prolonged convalescence time. In addition, suitable vascular access sites for interventional therapy can be problematic in the case of frequently accompanying peripheral vascular occlusive disease, sometimes to the extent that only transapical access routes are possible. A limited life expectancy, for example in the context of neoplastic diseases, can represent a contraindication for surgical and interventional therapies. There is currently no specific medical therapy that can affect initiation and progression of this important disease and that could serve as an alternative to valve replacement in this patient collective. A better understanding of the underlying complex pathophysiology has led to the development and evaluation of innovative therapeutic approaches. These novel pharmacological treatment strategies are all still being tested in preclinical and clinical trials and will be addressed in this review article.