Should We Intervene When Patients Have Asymptomatic, Severe Aortic Stenosis?

The 2020 guideline from the American College of Cardiology and American Heart Association recommends aortic valve (AV) intervention for severe aortic stenosis in patients with symptoms or signs of ventricular dysfunction. However, watchful waiting is the typical approach for patients with severe aortic stenosis and normal left-ventricular function who do not have symptoms. To evaluate whether patients with severe, asymptomatic aortic stenosis would benefit from early AV replacement (either transcatheter or surgical), researchers conducted a meta-analysis of four randomized, controlled trials that involved 1400 participants. The mean follow-up ranged from 42 to 74 months.