Severe aortic stenosis - would they really ‘watch and wait?’

[TheLostGloves]

I’m wondering if anyone has any experience of severe aortic stenosis in an elderly parent.

My understanding from limited googling is that surgery for a valve replacement is required in severe cases, as long as the patient is considered fit enough to cope with the surgery.

Does it seem likely that a consultant would propose to do nothing other than a review in 4-6 weeks, for a severe case? I am trying to work out whether:

• This could be considered a reasonable management plan if perhaps a patient has no symptoms
• This means that they feel it would not be possible to perform surgery on the patient
• My darling parent is trying to ‘protect’ me by not telling me the full story and/or has his head in the sand a bit about what needs to happen…!

Would love to hear any experiences. Thank you.

Well, I'm sure you've already looked this up but, for what it's worth, the NHS says:

• If you have an aortic valve disease and you have no or only mild symptoms, you'll probably just be monitored to check whether the condition is getting worse.
• If your symptoms become more severe, you'll probably need surgery to replace the valve.
• Without treatment, severe aortic valve disease is likely to get worse and may eventually be fatal.

They go on to say:

• Aortic valve replacement is the most effective treatment for aortic valve diseases. But it can place tremendous strain on the body and alternatives procedures may be needed.

It then lists other procedures that may be done instead.

The 2-year survival rate for severe disease is very poor.

Patient may have comorbid head in the sand disease?

Tell me about it. At this stage you know as much as me I’m afraid…

@TheLostGloves there is a procedure called a TAVI that less invasive than other methods, they are probably considering this. Main issues with severe aortic stenosis are when there is angina, fainting and shortness of breath. I'd say 4-6 weeks is a pretty short time for a review.

How old is the patient please?

My FIL90 has severe aortic stenosis and occasionally collapses. He also has advanced dementia and is bed bound and incontinent. As a family we have all agreed there is no point putting him through any sort of treatment in his condition. He would not understand and it wouldn’t give him better quality of life. We are hoping it might actually give him a quick and peaceful death instead of the extremely drawn out deterioration we have seen with dementia over 12 years. Clearly if your relative is otherwise healthy and active then surgery would be much more appropriate. I think they make the decision based on symptoms. Best wishes to you all.

@TopOfTheCliff ""We are hoping it might actually give him a quick and peaceful death instead of the extremely drawn out deterioration we have seen with dementia over 12 years."

oh I feel for you.

My dad had heart problems and decided to address them while knowing he had other health problems....

He fixed the heart issue....then had a long drawn out horrible death from the other stuff. Heart failure, while it can be slow, would have been better.

One day in hospital he looked at me sadly and said "the best thing now would be a massive heart attack". But he took that option away from himself. I kept quiet, of course.

OP I ask the patient's age because they might have opted for no surgery with full knowledge it might lead to a better death than if they do something to extend their life. They might be avoiding talking to you about it, not burying their head in the sand.