Aortic-Valve Replacement vs. Clinical Surveillance for Asymptomatic Severe Aortic Stenosis

A strategy of early AVR was superior to clinical surveillance due to a reduction in hospitalizations.

Although aortic-valve replacement (AVR) is recommended for severe, symptomatic aortic stenosis (AS), close clinical surveillance has been the standard of care for asymptomatic patients for more than 50 years. Two recent trials provide new data that challenge this recommendation.

In a manufacturer-funded randomized trial (EARLY TAVR; NCT03042104), early intervention with transcatheter AVR (TAVR) was compared with standard-of-care clinical surveillance among 901 patients with very severe AS and preserved ejection fraction. All patients were asymptomatic, confirmed by a treadmill test in >90%. At 5 years, the incidence of unplanned cardiac hospitalization, stroke, or death was significantly lower in the TAVR group than in the clinical-surveilla…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)