Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

Area of Science:

• Cardiology
• Cardiac Surgery
• Clinical Trials

Background:

• The optimal timing for surgical intervention in asymptomatic patients with severe aortic stenosis is a subject of ongoing debate.
• Current guidelines recommend conservative care for asymptomatic patients, but evidence supporting this approach is limited.

Purpose of the Study:

• To compare the outcomes of early aortic-valve replacement surgery versus conservative care in asymptomatic patients with very severe aortic stenosis.

Main Methods:

• A multicenter trial randomized 145 asymptomatic patients with very severe aortic stenosis to either early surgery or conservative care.
• The primary endpoint was a composite of death during or within 30 days after surgery, or cardiovascular death during follow-up.
• The secondary endpoint was all-cause mortality during follow-up.

Main Results:

• Early surgery was performed in 95% of patients within 2 months, with no operative mortality.
• The primary endpoint occurred in 1% of the early surgery group versus 15% in the conservative care group (hazard ratio, 0.09; P=0.003).
• All-cause mortality was 7% in the early surgery group compared to 21% in the conservative care group.

Conclusions:

• Early aortic-valve replacement surgery significantly reduces the risk of operative mortality or cardiovascular death in asymptomatic patients with very severe aortic stenosis.
• These findings suggest that early surgical intervention should be considered for asymptomatic patients with very severe aortic stenosis.