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Timing of Intervention in Asymptomatic Aortic Stenosis.

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Alternative Title
Circ J. 2021 Jun 25. doi: 10.1253/circj.CJ-21-0200.
Abstract
------------e-pub(22.1.12)-------
The decision to perform an intervention for asymptomatic severe aortic stenosis (AS) requires careful weighing of the risks of early intervention against those of watchful observation, and the optimal timing of intervention remains controversial. With improvements in surgical and postoperative care, long-term survival after surgical aortic valve (AV) replacement (AVR) is excellent in low-risk patients, and the emergence of transcatheter AVR may change the thresholds for early preemptive intervention, although a durability issue has to be resolved. A watchful observation strategy also has a risk of sudden death, irreversible myocardial damage, and increase in operative risk while waiting for symptoms to develop. We have been waiting for a prospective randomized trial to solve the intense debate between early AVR and watchful observation, and the RECOVERY (Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis) trial provides the evidence to support early AVR for asymptomatic severe AS. Risk assessment with severity of AS and staging classification may help to facilitate the identification of patients who may benefit from early intervention. Based on the results of the RECOVERY trial, early surgical AVR is reasonable for asymptomatic patients with very severe AS (aortic jet velocity ≥4.5 m/s) and low surgical risk. Further evidence is required to extend the indications of surgical AVR and to consider transcatheter AVR in asymptomatic patients with severe AS.

Keywords: Aortic stenosis; Aortic valve replacement; Early surgery; Trials.

Circ J. 2021 Jun 25. doi: 10.1253/circj.CJ-21-0200.
Author(s)
강덕현이승아
Issued Date
2021
Type
Article
Keyword
Aortic stenosisAortic valve replacementEarly surgeryTrials
DOI
10.1253/circj.CJ-21-0200
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7215
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2545990241&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Timing%20of%20Intervention%20in%20Asymptomatic%20Aortic%20Stenosis.&offset=0&pcAvailability=true
Publisher
CIRCULATION JOURNAL
Location
일본
Language
영어
ISSN
1346-9843
Citation Volume
1
Citation Number
1
Citation Start Page
10.1253
Citation End Page
10.1253
Appears in Collections:
Medicine > Medicine
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