Early surgery for asymptomatic severe aortic stenosis was discussed regarding its real-world applicability, as truly asymptomatic patients are uncommon in clinical practice.
To the Editor: In a field in which prior evidence has been largely observational, Kang et al. (March 26 issue) 1 conducted a randomized trial comparing 10-year outcomes of early surgery with those of conservative care in asymptomatic patients with very severe aortic stenosis. However, from a surgical perspective, several issues regarding real-world applicability merit consideration. Truly asymptomatic patients with severe aortic stenosis are uncommon in clinical practice; many patients gradually reduce their physical activity, thereby masking the onset of symptoms. Thus, the population described in the Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis (RECOVERY) . . .
“The lack of convergence of the curves for death from cardiovascular causes and death from any causes over this prolonged period of follow-up underscores the sustained benefits of early surgery. Accordingly, we believe that early aortic valve replacement may be the preferred strategy for asymptomatic patients with severe aortic stenosis (peak aortic jet velocity ≥ 4.5 m/s).”
A 2026 study conducted a letter in asymptomatic very severe aortic stenosis. Early surgery vs. conservative care was evaluated. Early surgery for asymptomatic severe aortic stenosis was discussed regarding its real-world applicability, as truly asymptomatic patients are uncommon in clinical practice.