Asymptomatic Severe Aortic Stenosis: When to Intervene?

Current guidelines on aortic stenosis recommend waiting for the onset of symptoms before considering aortic valve replacement (AVR). However, the increasing capability to treat aortic stenosis opens the question of whether surgery might best be performed before symptoms develop. Investigators made use of the CURRENT AS registry, which enrolls consecutive patients with severe aortic stenosis at 27 sites in Japan, to examine 5-year outcomes from asymptomatic patients who either underwent initial AVR or were treated conservatively (watchful waiting). Severe aortic stenosis was defined as peak aortic jet velocity >4.0 milliseconds, mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm².

Among 1808 asymptomatic patients in the reg…