Key result
SAVR in asymptomatic patients is linked to ~19% higher 10-year survival versus symptomatic patients.
Why the study?
Recent evidence supports early intervention in asymptomatic severe AS with normal EF, prompting a comparison of longitudinal SAVR outcomes between asymptomatic and symptomatic patients with normal LVEF.
Does early surgical aortic valve replacement (SAVR) improve long-term survival compared to waiting for symptom onset in patients with severe aortic stenosis and preserved LVEF?
Cohort (n=17,683)
Yes
Does early surgical aortic valve replacement (SAVR) improve long-term survival compared to waiting for symptom onset in patients with severe aortic stenosis and preserved LVEF?
In patients with severe aortic stenosis and preserved LVEF, surgical aortic valve replacement prior to symptom onset is associated with superior 10-year survival compared to waiting for symptoms.
Answers are grounded in this paper and cite their sources.
May support earlier SAVR in asymptomatic severe AS; leaves open confirmation by randomized trials.
BACKGROUND: Recent evidence supports early intervention in patients with asymptomatic aortic stenosis (AS) and normal ejection fraction. The study objective was to compare longitudinal surgical aortic valve replacement (SAVR) outcomes in asymptomatic versus symptomatic patients with normal left ventricular ejection fraction (LVEF). METHODS: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was leveraged to identify patients who underwent isolated SAVR for asymptomatic or symptomatic severe AS with LVEF≥50% between July 2011 and June 2022. The cohort was linked to Centers for Medicare & Medicaid Services data. The primary outcome was risk-adjusted 10-year survival. Subgroup analysis evaluated long-term survival stratified by age, LVEF, and STS predicted risk of mortality (PROM). RESULTS: A total of 17,683 patients with LVEF≥50% underwent isolated SAVR, 16,284 (92.1%) were symptomatic and 1,399 (7.9%) were asymptomatic. Compared to symptomatic patients, asymptomatic patients were younger (mean age 74.2 years vs 75.0 years, p<0.001) and had lower STS PROM (1.9%±1.4 vs 2.5%±2.0, p<0.001). Following risk adjustment, asymptomatic patients demonstrated superior 10-year survival compared to symptomatic patients (aHR 1.19 [95% CI 1.09-1.29]). In subgroup analyses, long-term survival benefit was more pronounced in asymptomatic versus symptomatic patients aged ≥75 years (aHR 1.24 [95% CI 1.11-1.39]), LVEF ≥60% (aHR 1.20 [95% CI 1.08-1.34]) and STS PROM <2 (aHR 1.17 [95% CI 1.01-1.34]). CONCLUSIONS: In patients with severe AS and preserved LVEF, SAVR prior to symptom onset shows superior long-term survival. This study supports early SAVR in carefully selected patients with asymptomatic severe AS.
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Braasch et al. (2026) conducted a cohort in Severe aortic stenosis with preserved ejection fraction (n=17,683). Asymptomatic severe aortic stenosis vs. Symptomatic severe aortic stenosis was evaluated on Risk-adjusted 10-year survival (aHR 1.19, 95% CI 1.09-1.29). SAVR in asymptomatic patients with severe aortic stenosis and preserved LVEF was associated with superior 10-year survival compared to symptomatic patients (aHR 1.19; 95% CI 1.09-1.29).
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