Early Surgery for Asymptomatic, Very Severe Aortic Stenosis?

Valve replacement is recommended for symptomatic severe aortic stenosis, but should we be intervening earlier? To learn more, Korean researchers randomized 145 asymptomatic patients with very severe stenosis (valve area ≤0.75 cm²; peak aortic velocity of ≥4.5 m/second or mean gradient of ≥50 mm Hg) to receive surgical aortic-valve replacement or conservative, guideline-based medical treatment (NCT01161732).

There was a 5% crossover to conservative treatment in the surgical group; 3% of the conservative group underwent early surgery. Median follow-up was 6 years. The composite endpoint of 30-day operative mortality or death from cardiovascular causes during follow-up occurred significantly less commonly in the surgical group (1% vs. 15%). Ult…