- Despite low overall sudden-death rates in patients with asymptomatic aortic stenosis (AS), those with very severe AS have higher mortality even after aortic valve replacement (AVR).
- Authors suggest close follow-up for those with moderate AS plus peak aortic jet velocity of ≥3.0 m/second or left ventricular ejection fraction (LVEF)
- Trial comparing transcatheter AVR to surveillance is underway.
- Editorial: if validated, results could "influence decision making and the timing of surgical referral."
Why this matters
- It is unclear at what stage to offer AVR to asymptomatic patients.
- Mean follow-up, 27 months.
- 39.4% underwent AVR; 30-day postprocedural mortality: 0.9%.
- Survival at 2, 4, and 8 years (medical management):
- Overall: 93%, 86%, 75%, respectively;
- Cardiovascular death-free: 96%, 90%, 83%;
- Overall, with baseline severe AS: 92%, 80%, 65%;
- AVR-free, with baseline severe AS: 54%, 32%, 12%.
- Sudden death: 0.65%.
- With severe AS, peak aortic jet velocity >5 m/second and LVEF
- Retrospective analysis of Heart Valve Clinic International Database (n=1375).
- Patients were asymptomatic at baseline with AV area ≤1.5 cm2, LVEF >50%.
- Outcomes: AVR, survival, natural history.
- Funding: None disclosed; authors report industry ties.
- Progression rate not monitored.