SAVR a valuable treatment option for asymptomatic patients with severe AS

Asymptomatic patients with severe aortic stenosis (AS) may benefit from early surgery, according to a new analysis published in Circulation.

“Indications for valve replacement in asymptomatic patients with severe AS remain a matter of debate,” wrote first author Marko Banovic, MD, PhD, a cardiologist at the University Clinical Center of Serbia, and colleagues. “The problem is of importance since almost a quarter of patients with severe AS referred to the hospital for the evaluation of severe AS were asymptomatic in a recent survey, and the proportion is likely to be higher in the general population.”

To learn more about this common scenario, Banovic et al. examined data from 157 patients who were treated from June 2015 to September 2020 in one of seven European countries. The mean patient age was 67 years old, and 57% were men. The cause of the AS was degenerative valvular disease for 84.7% of patients, bicuspid aortic valve in 14% and rheumatic valvular disease in 1.3%.

While 78 patients were randomly chosen to undergo surgical aortic valve replacement (SAVR), the other 79 underwent conservative treatment. Six members of the SAVR group did not actually go through with the procedure for a variety of reasons, leaving 72 patients in SAVR group; they all underwent the procedure within eight weeks of randomization. Follow-up continued through May 2021, and the median follow-up period was 28 months for the SAVR group and 35 months for the conservative group.

Overall, the composite endpoint of all-cause mortality, AMI, stroke or unplanned heart failure hospitalization was seen in 15.2% of SAVR patients and 34.7% of the conservative group. There were no significant differences in secondary outcomes that examined all-cause mortality, heart failure hospitalizations, major bleeding events and thromboembolic complications separately, but “trends were consistent with the primary outcome.”

“These findings advocate that once AS becomes significant, early valve replacement improves patient outcomes regardless of the symptom status,” the authors concluded.

Read the full study here.

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