Key result
Proactive management with prompt valve replacement is advocated over watchful waiting for severe AS.
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Why the study?
Recent 2025 ESC/EACTS guidelines challenge symptom-driven watchful waiting in severe aortic stenosis, prompting a need for a contemporary operational framework supporting proactive management.
This expert perspective advocates for a proactive management strategy for severe aortic stenosis, including earlier intervention in asymptomatic patients, aligning with the 2025 ESC/EACTS guidelines.
The 2025 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines mark a pivotal change, challenging the paradigm of symptom-driven watchful waiting, and supporting earlier treatment in many patients with asymptomatic severe aortic stenosis. Building on this foundation, this international expert perspective advocates a comprehensive, proactive management strategy and offers clinicians a contemporary operational framework for managing severe aortic stenosis. Key evidence-based elements include early referral to the multidisciplinary Heart Valve Team, streamlined evaluation, upstream testing, prompt aortic valve replacement in many asymptomatic patients, more urgent treatment for symptomatic patients, and structured surveillance involving close working relationships between the referring clinician and Heart Valve Team when intervention is deferred. This proactive evidence-based model aims to improve timeliness, efficiency, and equity of care, thereby reducing preventable morbidity and mortality and improving long-term outcomes.
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Cook et al. (2025) conducted a review in Severe aortic stenosis. Proactive management strategy vs. Symptom-driven watchful waiting was evaluated. A proactive management strategy for severe aortic stenosis, including prompt valve replacement, is advocated over watchful waiting to reduce preventable morbidity and mortality.
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