Patients with severe asymptomatic aortic stenosis may benefit more from an aggressive strategy of early valve replacement than from a conservative watch-and-wait approach, according to a new research published in the Annals of Thoracic Surgery.
The study included 265 patients. Aortic valve replacement (AVR) was recommended in 104, and watchful waiting (WW) was recommended in 161. Probabilities of undergoing surgery and of death from recommendation date were estimated using a multi-state model. Cox regression analysis was used to determine independent risk factors for death.
Probability of death at one year after recommendation was 5.2 per cent in the WW group and 4.7 per cent in the AVR group. However, the study found that at two years after recommendation, survival in the AVR-recommended group was 92.5 per cent versus 83.9 per cent in the WW group (P=.044). Undergoing surgery was independently associated with higher survival in the AVR-recommended group (hazard ratio [HR] 0.17; P=.038) and WW group (HR 0.39; P=.044).
While the study demonstrated a 'safe' period for WW for up to one year, the authors said the data at two years suggest there is a benefit to early AVR.