The ‘wait for symptoms’ strategy in asymptomatic severe aortic stenosis

Heart ◽  
2020 ◽  
Vol 106 (23) ◽  
pp. 1792-1797 ◽  
Author(s):  
José Alberto San Román ◽  
Isidre Vilacosta ◽  
Manuel J Antunes ◽  
Bernard Iung ◽  
Javier Lopez ◽  
...  
Keyword(s):  
Natural History ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Randomised Trials ◽  
Calcific Aortic Stenosis ◽  
Randomised Study ◽  
Asymptomatic Patients ◽  
History Of ◽  
Shed Light

Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.

scholarly journals Outcomes in asymptomatic, severe aortic stenosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249610
Author(s):  
Anette Borger Kvaslerud ◽  
Kenan Santic ◽  
Amjad Iqbal Hussain ◽  
Andreas Auensen ◽  
Arnt Fiane ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Asymptomatic Patients ◽  
History Of ◽  
Artery Disease

Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.

scholarly journals Timing of Intervention in Asymptomatic Patients with Aortic Stenosis

2021 ◽  
Vol 16 ◽  
Author(s):  
Teresa Sevilla ◽  
Ana Revilla-Orodea ◽  
J Alberto San Román
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Perioperative Complications ◽  
Scientific Evidence ◽  
Optimal Timing ◽  
Common Disease ◽  
Asymptomatic Patients

Aortic stenosis is a very common disease. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Continuous advances in both surgical and percutaneous techniques have substantially decreased rates of perioperative complications and mortality; with this in mind, many authors suggest that earlier intervention in patients with severe aortic stenosis, when they are still asymptomatic, may be indicated. This paper summarises what is known about the natural history of severe aortic stenosis and the scientific evidence available about the optimal timing for aortic valve replacement.

scholarly journals Natural History of Very Severe Aortic Stenosis

Circulation ◽  
2010 ◽  
Vol 121 (1) ◽  
pp. 151-156 ◽  
Author(s):  
Raphael Rosenhek ◽  
Robert Zilberszac ◽  
Michael Schemper ◽  
Martin Czerny ◽  
Gerald Mundigler ◽  
...  
Keyword(s):  
Natural History ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
History Of

scholarly journals Natural history of severe aortic stenosis: Diastolic wall strain as a novel prognostic marker

2017 ◽  
Vol 34 (4) ◽  
pp. 484-490 ◽  
Author(s):  
Edinrin Obasare ◽  
Vikas Bhalla ◽  
Deepakraj Gajanana ◽  
Mary Rodriguez Ziccardi ◽  
Jose N. Codolosa ◽  
...  
Keyword(s):  
Natural History ◽  
Aortic Stenosis ◽  
Prognostic Marker ◽  
Severe Aortic Stenosis ◽  
Diastolic Wall Strain ◽  
History Of

scholarly journals NATURAL HISTORY OF SEVERE AORTIC STENOSIS WITH PRESERVED EJECTION FRACTION: IMPACT OF TRANSVALVULAR GRADIENTS AND FLOW

2013 ◽  
Vol 61 (10) ◽  
pp. E1979
Author(s):  
Frédéric Maes ◽  
Jamila Boulif ◽  
Christophe De Meester ◽  
Julie Melchior ◽  
Bernhard Gerber ◽  
...  
Keyword(s):  
Natural History ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Preserved Ejection Fraction ◽  
History Of
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