Key result
The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe aortic stenosis.
Why the study?
Does aortic valve replacement or medical therapy improve outcomes in patients with asymptomatic severe aortic stenosis?
Does aortic valve replacement or medical therapy improve outcomes in patients with asymptomatic severe aortic stenosis?
For most patients with asymptomatic severe aortic stenosis, careful monitoring using clinical and echocardiographic parameters is recommended as the risks of aortic valve replacement currently outweigh the benefits.
May support watchful waiting over early AVR in asymptomatic severe AS; leaves open need for randomized confirmation.
Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement surgery, but the management of patients with asymptomatic severe AS is more controversial. While cholesterol and angiotensin have been linked to AS progression, we should await the results of ongoing randomized trials before medical therapy to lower cholesterol or inhibit angiotensin can be recommended to limit disease progression. Clinical factors, echocardiographic parameters, valve morphology, exercise stress testing results, and cardiac biomarkers may be useful in identifying patients who will have early development of symptoms during follow-up and require closer monitoring. The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe AS.
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Stewart et al. (2009) conducted a review in Asymptomatic severe aortic stenosis. Aortic valve replacement was evaluated. The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe aortic stenosis.
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