Calcific Aortic Stenosis

Calcific aortic stenosis is the number 1 cause for surgical valve replacement in the United States and Europe. In 2006, surgical valve replacement still remains the number 1 indication for the treatment of this disease process, as defined by the American College of Cardiology/American Heart Association guidelines for valvular heart disease by Bonow et al.1 This standard of care for patients with severe symptomatic aortic stenosis requiring surgical valve replacement was defined in 1968 by Ross and Braunwald2 as the main therapy for this disease. For years, this disease has been described as a passive process that develops secondary to serum calcium attaching to the valve leaflet surface to cause nodule formation. Therefore, surgical replacement of the valve is the obvious approach toward relieving outflow obstruction in these patients. Until recently, the lack of experimental models in this field has limited our understanding of the disease.Article p 2065 In the middle of the last century, the field of cardiology was in a similar position with our understanding of coronary vascular atherosclerosis. This was summarized in 1942 by Dr James B. Herrick,3 who wrote a short history of cardiology. In the chapter on coronary atherosclerosis, he predicted the future of therapeutic approaches for vascular atherosclerosis. In this textbook, he wrote of heart disease: “This is the story of a bad disease. … The outlook for dread angina it thought to be more favorable than it was first thought … though the cause … has not been discovered, and vascular disease may never be warded off or cured, research may unearth secrets by which premature or old age may be post-poned.” In 2006, we are in a unique position to predict that therapeutic approaches for calcific aortic stenosis will be possible with the emergence of models that recapitulate …