Low-flow Low-gradient Aortic Stenosis: Foundations, Challenges, and Solutions

Abstract Purpose of Review This review aims to provide a comprehensive update to healthcare providers on the assessment and subsequent management of low-flow aortic stenosis. Recent Findings An aging population with a greater burden of cardiovascular risk factors has contributed to an increasing prevalence of aortic stenosis. The classification of the discordant low-flow cohort of aortic stenosis remains difficult and sub-optimal in the face of a heterogeneous disease population. Recent research has investigated use of echocardiographic flow parameters to categorise and prognosticate the low-flow aortic stenosis cohort. There is an increased awareness of the overlap between cardiac amyloidosis and the low-flow aortic stenosis group which has treatment implications. TAVI holds promise as a safer alternative to SAVR in this multimorbid, high-risk patient cohort. Summary Assessment and management of the low-flow aortic stenosis group needs to be highly individualised according to phenotype and comorbidities. This is best managed within the multidisciplinary Heart Team approach.