Asymptomatic Severe Aortic Valve Stenosis—When to Intervene: a Review of the Literature, Current Trials, and Guidelines
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Purpose of Review
The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients.
Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death. A significant proportion of these patients develop AS-related symptoms within 1 or 2 years. Clinical and echocardiographic characteristics are predictors of poor outcomes and can guide treatment decisions. Several non-randomized studies and meta-analyses have suggested benefit from early AVR for asymptomatic severe AS, including improved all-cause, cardiovascular, and valve-related mortality. Based on the available information, current guidelines suggest aortic valve replacement in the presence of specific characteristic, including left ventricular dysfunction and very severe AS with significantly elevated gradients.
Although the available data suggests early AVR improves the clinical outcomes of these patients, most patients in current practice are managed conservatively. Six randomized trials are ongoing to better elucidate the ideal management of asymptomatic severe AS patients.
KeywordsAortic valve Severe aortic stenosis Asymptomatic Aortic valve replacement
Compliance with Ethical Standards
Conflict of Interest
Andrés M. Pineda and Todd L. Kiefer declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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