Key result
Early surgery reduces 10-year operative or CV death vs conservative care in asymptomatic very severe AS.
Why the study?
Does early surgery reduce the composite of operative mortality or cardiovascular death in asymptomatic patients with very severe aortic stenosis?
RCT (n=145)
1:1
Does early surgery reduce the composite of operative mortality or cardiovascular death in asymptomatic patients with very severe aortic stenosis?
In asymptomatic patients with very severe aortic stenosis, early surgery provides a significant long-term survival benefit over conservative care at 10 years.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The lack of convergence of the curves for death from cardiovascular causes and death from any causes over this prolonged period of follow-up underscores the sustained benefits of early surgery. Accordingly, we believe that early aortic valve replacement may be the preferred strategy for asymptomatic patients with severe aortic stenosis (peak aortic jet velocity ≥ 4.5 m/s).”
“In patients with severe aortic stenosis, even during the asymptomatic period, the narrowing of the valve worsens and damages the heart, increasing the risk of sudden death. Even without symptoms, patients diagnosed with severe aortic stenosis on echocardiography should seek early treatment.”
“Long-term follow-up data are necessary to evaluate whether these benefits would be sustained, given that the long-term risks related to prosthetic valves, including bioprosthetic valve degeneration.”
Supports early surgery in asymptomatic very severe AS; confirms sustained benefit in long-term RCT follow-up.
BACKGROUND: Among asymptomatic patients with severe aortic stenosis, a previous analysis showed that the risk of a composite of death during surgery or within 30 days after surgery (called operative mortality) or death from cardiovascular causes was significantly lower with early surgery than with conservative care. However, the long-term survival benefit of early surgery, as compared with conservative care, remains unclear. METHODS: We randomly assigned asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with a peak aortic jet velocity of ≥4.5 m per second) in a 1:1 ratio to undergo early surgery or receive conservative care. The primary end point was a composite of operative mortality or death from cardiovascular causes during the 10-year follow-up period. RESULTS: A total of 145 patients underwent randomization. In an intention-to-treat analysis, a primary end-point event occurred in 2 of 73 patients (3%) in the early-surgery group and in 17 of 72 (24%) in the conservative-care group (hazard ratio, 0.10; 95% confidence interval [CI], 0.02 to 0.43; P = 0.002). At 10 years, the cumulative incidence of operative mortality or death from cardiovascular causes was 1% in the early-surgery group and 19% in the conservative-care group. Death from any cause occurred in 11 patients (15%) in the early-surgery group and in 23 (32%) in the conservative-care group (hazard ratio, 0.42; 95% CI, 0.21 to 0.86). CONCLUSIONS: Among asymptomatic patients with very severe aortic stenosis, early surgery led to a lower risk of a composite of operative mortality or death from cardiovascular causes than conservative care at 10 years. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.).
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Kang et al. (2026) conducted an RCT in asymptomatic very severe aortic stenosis (n=145). Early surgery vs. Conservative care was evaluated on Composite of operative mortality or death from cardiovascular causes (HR 0.10, 95% CI 0.02-0.43, p=0.002). Early surgery significantly reduced the risk of operative mortality or cardiovascular death compared to conservative care in asymptomatic very severe aortic stenosis (HR 0.10; 95% CI 0.02-0.43; P=0.002).
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