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Management of Asymptomatic Severe Aortic Stenosis: Current Evidence and Future Directions

Giulia Laterra1,2, Federica Agnello1,2, Orazio Strazzieri2

  • 1Faculty of Medicine and Surgery, Università degli Studi di Enna "Kore", Piazza dell'Università, 94100 Enna, Italy.

Journal of Clinical Medicine
|November 13, 2025
PubMed

Insights

Severe aortic stenosis (AS) management is complex. Early aortic valve replacement (AVR) may benefit high-risk patients, reducing hospitalizations but not necessarily mortality.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Clinical Decision-Making

Background:

  • Severe aortic stenosis (AS) is a common, progressive valvular heart disease.
  • Management of asymptomatic severe AS is challenging, requiring individualized approaches.
  • Optimal intervention timing for asymptomatic severe AS is debated.

Purpose of the Study:

  • To review current strategies for managing asymptomatic severe aortic stenosis.
  • To highlight the role of risk stratification in guiding intervention decisions.
  • To discuss the implications of recent clinical trial data on management.

Main Methods:

  • Systematic review of guidelines and recent randomized controlled trials.
  • Analysis of risk stratification parameters including clinical, echocardiographic, biomarker, and advanced imaging data.
  • Evaluation of outcomes related to early versus delayed aortic valve replacement (AVR).

Main Results:

  • Guidelines recommend AVR for severe AS with reduced left ventricular ejection fraction (LVEF), irrespective of symptoms.
  • For preserved LVEF, AVR decisions require comprehensive risk assessment.
  • Recent trials show reduced heart failure hospitalizations with early AVR but mixed mortality benefits.

Conclusions:

  • Individualized risk assessment is crucial for managing asymptomatic severe AS with preserved LVEF.
  • Timely AVR in selected high-risk patients may improve long-term outcomes.
  • Avoiding unnecessary procedures in low-risk patients is essential.

Keywords:
Asymptomatic Severe Aortic Stenosisaortic valve replacementtranscatheter aortic valve replacement

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