Key result
Early aortic valve replacement in asymptomatic severe aortic stenosis reduces cardiovascular events compared to watchful waiting, highlighting the need for earlier diagnosis and a lifetime-oriented management approach.
Why the study?
Calcific aortic stenosis is frequently underdiagnosed and undertreated, with up to 40% of symptomatic severe cases not undergoing valve intervention despite poor survival.
This review highlights the paradigm shift towards earlier intervention in aortic stenosis and emphasizes the critical need for lifetime management planning as TAVI expands to younger, lower-risk populations.
Supports earlier intervention in asymptomatic severe aortic stenosis; leaves open optimal timing, patient selection, and lifetime management.
Background Calcific aortic stenosis (AS) is the most relevant valvular heart disease in aging populations and remains both underdiagnosed and undertreated. Screening studies reveal a high prevalence of unrecognized disease, while up to 40% of patients with symptomatic severe AS do not undergo valve intervention, resulting in poor survival. No pharmacologic therapy has yet altered disease progression, although targeted approaches such as lipoprotein(a) inhibition are under investigation. Methods This paper provides a comprehensive perspective review of the evolving epidemiology, timing of intervention, and long‐term management of aortic stenosis, drawing on randomized trials and contemporary clinical data. Results Randomized trials have challenged the traditional watchful waiting strategy in asymptomatic severe AS, showing that early aortic valve replacement (AVR) reduces cardiovascular events, though survival benefit depends on patient selection and timing. Moderate AS is increasingly recognized as a high‐risk condition, prompting ongoing trials evaluating earlier intervention. As transcatheter aortic valve implantation (TAVI) expands to younger, lower‐risk patients, long‐term issues—including conduction disturbances, paravalvular leak, cerebrovascular events, valve hemodynamics and durability, and redo feasibility—become central to care. Contemporary data suggest comparable mid‐term durability between TAVI and surgery, but lifetime management planning is essential. Conclusions Optimal care of aortic stenosis requires earlier diagnosis, optimized procedural strategies, and a lifetime‐oriented approach to management, supported by continued investigation into pharmacologic therapy and the timing of intervention.
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Cozzi et al. (2026) conducted a review in Aortic Stenosis. Early aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) vs. Watchful waiting / conservative management was evaluated. Early aortic valve replacement in asymptomatic severe aortic stenosis reduces cardiovascular events compared to watchful waiting, highlighting the need for earlier diagnosis and a lifetime-oriented management approach.
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