A Contemporary Approach to the Management of Asymptomatic Severe Aortic Stenosis

Asymptomatic severe aortic stenosis (AS) is characterized by a prolonged latent phase during which progressive valvular obstruction and myocardial remodeling may occur despite preserved left ventricular ejection fraction and the absence of overt clinical symptoms. Historically, management has favored watchful waiting until symptom onset or guideline-defined triggers emerge; however, recent randomized data challenge this conservative paradigm. This review summarizes the natural history, risk stratification, and contemporary management of asymptomatic severe AS, with a focus on emerging insights that inform the timing of intervention. We propose an individualized, contemporary framework for managing asymptomatic severe AS that integrates multimodal risk assessment, procedural risk, and shared decision-making, and we outline future directions aimed at refining patient selection and optimizing the personalized timing of intervention.