Valve Surgery for Asymptomatic Patients with Very Severe Aortic Stenosis

Current practice guidelines do not recommend aortic valve replacement (AVR) for asymptomatic patients with severe aortic stenosis (AS). However, advances in surgical techniques and prosthetic-valve technology prompted investigators in Korea to compare AVR with conventional care in this population. From 1996 to 2006, they enrolled 197 consecutive asymptomatic patients (mean age, 63; maximum age, 85) with very severe AS (mean peak aortic velocity ≥4.5 meters/second or mean transaortic pressure gradient ≥50 mm Hg); 61% had AS of bicuspid or rheumatic etiology. In consultation with their physicians, 95 patients chose conventional care and 102 chose AVR. Patients with left ventricular systolic dysfunction, mitral valve disease, or coronary arter…