Timing of Intervention in Asymptomatic Aortic Stenosis

The decision to perform an intervention for asymptomatic severe aortic stenosis (AS) requires careful weighing of the risks of early intervention against those of watchful observation, and the optimal timing of intervention remains controversial. With improvements in surgical and postoperative care,...

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Bibliographic Details
Published in:Circulation Journal 2022/02/25, Vol.86(3), pp.376-382
Main Authors: Lee, Seung-Ah, Kang, Duk-Hyun
Format: Article
Language:English
Subjects:
Aortic stenosis
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic valve replacement
Aortic Valve Stenosis
Early surgery
Heart Valve Prosthesis Implantation - adverse effects
Humans
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Treatment Outcome
Trials
Watchful Waiting
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Summary:The decision to perform an intervention for asymptomatic severe aortic stenosis (AS) requires careful weighing of the risks of early intervention against those of watchful observation, and the optimal timing of intervention remains controversial. With improvements in surgical and postoperative care, long-term survival after surgical aortic valve (AV) replacement (AVR) is excellent in low-risk patients, and the emergence of transcatheter AVR may change the thresholds for early preemptive intervention, although a durability issue has to be resolved. A watchful observation strategy also has a risk of sudden death, irreversible myocardial damage, and increase in operative risk while waiting for symptoms to develop. We have been waiting for a prospective randomized trial to solve the intense debate between early AVR and watchful observation, and the RECOVERY (Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis) trial provides the evidence to support early AVR for asymptomatic severe AS. Risk assessment with severity of AS and staging classification may help to facilitate the identification of patients who may benefit from early intervention. Based on the results of the RECOVERY trial, early surgical AVR is reasonable for asymptomatic patients with very severe AS (aortic jet velocity ≥4.5 m/s) and low surgical risk. Further evidence is required to extend the indications of surgical AVR and to consider transcatheter AVR in asymptomatic patients with severe AS.
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-21-0200