Key result
Aortic valve replacement in initially asymptomatic patients with severe aortic stenosis was associated with higher 10-year overall survival compared to no AVR (69.4% vs 28.2%; p<0.001).
Why the study?
The exact timing of aortic valve replacement in asymptomatic patients with severe aortic stenosis remains a matter of debate.
Does aortic valve replacement improve survival in asymptomatic patients with severe aortic stenosis?
Cohort (n=59)
Does aortic valve replacement improve survival in asymptomatic patients with severe aortic stenosis?
Absolute Event Rate: 69.4% vs 28.2%
p-value: p=<0.001
In initially asymptomatic patients with severe aortic stenosis, the majority develop symptoms over time, and undergoing aortic valve replacement is associated with significantly improved long-term survival.
May support early AVR consideration in asymptomatic severe AS; hypothesis-generating and requires RCTs before practice change.
Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. Methods: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). Conclusions: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.
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Çelik et al. (2021) conducted a cohort in Asymptomatic severe aortic stenosis (n=59). Aortic valve replacement (AVR) vs. Conservative management (no AVR) was evaluated on 10-year overall survival (p=<0.001). Aortic valve replacement in initially asymptomatic patients with severe aortic stenosis was associated with higher 10-year overall survival compared to no AVR (69.4% vs 28.2%; p<0.001).
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