Why the study?
Calcific aortic stenosis is prevalent, but the therapeutic approach in asymptomatic aortic stenosis is not well established and existing evidence supporting early replacement has important drawbacks.
Does early valve replacement improve prognosis compared to a 'wait for symptoms' strategy in asymptomatic patients with severe aortic stenosis?
Does early valve replacement improve prognosis compared to a 'wait for symptoms' strategy in asymptomatic patients with severe aortic stenosis?
The authors argue against early valve replacement in asymptomatic severe aortic stenosis, recommending a 'wait for symptoms' strategy pending results from ongoing randomized trials.
Answers are grounded in this paper and cite their sources.
Advises against routine early valve replacement in asymptomatic severe aortic stenosis; leaves open optimal timing until randomized trials report.
Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.
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Román et al. (2020) studied this question.
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