Why the study?
Recent diagnostic, risk-stratification, and procedural advances, alongside emerging evidence for early intervention, have prompted reconsideration of timing and treatment strategies for aortic stenosis.
This review discusses the emerging evidence and dilemmas regarding early valve replacement in asymptomatic severe and symptomatic moderate aortic stenosis.
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Decisions on early valve replacement in asymptomatic severe or symptomatic moderate AS should not yet change practice; leaves open optimal timing pending RCTs.
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
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Banović et al. (2023) studied this question.
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