Well, as one who has "pulled the plug" on my (former) cardio and gone to the surgeon, tests and files in hand, I can empathize with your quandary. Cardiologists do not always provide the go-ahead when you feel the time is right. They have a tendency to want to keep you from the surgery as long as possible. This is because there is a fatality rate (about 1%) for patients in otherwise normal health, and because the surgery is life-altering. A loose rule of thumb (similar to what Jim has pointed out) is that Cardiologists tend to want to help us avoid the immediate danger of the surgery, and surgeons want avoid waiting, so they are operating on the strongest heart they can, and so the heart is least likely to remain compromised after the surgery heals.
However, some of us know what we're expecting, and feel competent to push that decision, assuming that the surgery and our disease state fall into the normal bounds of ethical medical professional practice.
The defacto standard for surgery for aortic stenosis is when the valve opening is less than 1.0 cm². Some doctors like to wait longer, even as low as .6 cm² (mostly the cardiologists, rather than the cardio-thoracic surgeons). I personally feel that is way too long for most patients. Additionally, most cardiologists and surgeons would like to know that you are experiencing symptoms that show that your heart is under severe stress.
You are on the cusp, but not quite there yet. Your gradients are high, and your stenosis is at the point where the calcification is classically also causing regurgitation (insufficiency) by blocking the valve from closing properly as well as opening fully. Likely, it won't be long for your valve opening to get defensibly under 1.0 cm². (May show as aortic opening, effective valve opening, valve area, aortic aperture, or similar wording on echo report.) The speed of calcification accelerates with time: the worse it gets, the faster it gets worse. Tally your symptoms, and make sure your cardiologist is aware of them. Ask for an echo in six months, if they're not already suggesting that.
That being said, your heart is not typical for this situation. Your left ventricle is dilated, not specifically muscularly enlarged: it's contracting with less vigor than normal, and you are experiencing akinesis (lack of muscle contraction) in the interior wall of that ventricle. Your ejection fraction (EF) is normal, but at the very low end of normal. Most hearts in this situation are muscularly enlarged and pumping like athelete's hearts, with EFs in the mid to high sixties. This should also play into the decision, especially in terms of performing the surgery while your heart is in its best possible condition. It may raise your operative risk to some slight extent, although I couldn't guess how much. Ask the surgeon about that.
I don't think that most surgeons would go for it quite yet, but I don't think it far on the horizon. Likely, your next echo (in six months) will put you undeniably into the ethically operable category.
Without question, waiting is the hardest part .
Best wishes,
