Should We Perform Valve Replacement for Severe Asymptomatic Aortic Stenosis?

A small randomized trial adds to a growing literature suggesting important benefits from aortic valve replacement in asymptomatic patients.

Aortic valve replacement is indicated for patients with severe symptomatic aortic stenosis to improve both symptoms and long-term prognosis. For patients without symptoms, however, current guidelines recommend considering aortic valve replacement only at the time of other cardiac surgery or in cases of very severe aortic stenosis or an abnormal exercise test (suggesting unrecognized symptoms). Nonetheless, patients managed with “watchful waiting” may experience sudden cardiac death or develop irreversible left ventricular dysfunction. Whether early valve replacement can avoid these complications and improve outcomes remains uncertain.

To test the benefit of this approach, in an open-label, investigator-initiated trial, the AVATAR investigato…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)