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Timing of Intervention in Asymptomatic Aortic Stenosis
- Source :
- Circulation Journal. 86:376-382
- Publication Year :
- 2022
- Publisher :
- Japanese Circulation Society, 2022.
-
Abstract
- 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.
- Subjects :
- Aortic valve
medicine.medical_specialty
Risk Assessment
Severity of Illness Index
Sudden death
Asymptomatic
law.invention
Aortic valve replacement
Randomized controlled trial
Risk Factors
law
Intervention (counseling)
medicine
Humans
Prospective Studies
Watchful Waiting
Heart Valve Prosthesis Implantation
business.industry
Aortic Valve Stenosis
General Medicine
medicine.disease
Surgery
Stenosis
Treatment Outcome
medicine.anatomical_structure
Aortic Valve
medicine.symptom
Cardiology and Cardiovascular Medicine
Risk assessment
business
Subjects
Details
- ISSN :
- 13474820 and 13469843
- Volume :
- 86
- Database :
- OpenAIRE
- Journal :
- Circulation Journal
- Accession number :
- edsair.doi.dedup.....1940a14155e9a1eb65fe34147935f117