Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

This multicenter randomized trial compared early aortic-valve replacement with guideline-recommended conservative care in 145 asymptomatic patients with very severe aortic stenosis. Early surgery significantly reduced the incidence of operative mortality or death from cardiovascular causes (1% vs. 15%), with no operative deaths reported. Secondary endpoints including death from any cause and hospitalization for heart failure were also lower in the early-surgery group. The findings support the benefit of early intervention in select asymptomatic patients, particularly in centers with low surgical risk, and suggest reconsidering current guidelines.

This multicenter randomized trial compared early aortic-valve replacement with guideline-recommended conservative care in 145 asymptomatic patients with very severe aortic stenosis. Early surgery significantly reduced the incidence of operative mortality or death from cardiovascular causes (1% vs. 15%), with no operative deaths reported. Secondary endpoints including death from any cause and hospitalization for heart failure were also lower in the early-surgery group. The findings support the benefit of early intervention in select asymptomatic patients, particularly in centers with low surgical risk, and suggest reconsidering current guidelines.