Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis

Early surgery appears a better option than conventional management among asymptomatic patients with severe aortic stenosis (AS), according to new findings presented at the American Heart Association 2019 Scientific Sessions in Philadelphia.

Study researchers randomly assigned asymptomatic patients with severe AS to either undergo early surgery (n=73) or receive conventional treatment (n=72). The key endpoint was defined as a composite of operative mortality or cardiovascular (CV) death, while the secondary endpoint was all-cause mortality. The subjects were followed-up on for an average of 6.2 years.

Both treatment groups were generally well balanced with respect to baseline clinical characteristics. The researchers observed that in the early surgery group, 94.5% of patients underwent surgery within two months after randomization, and 72.2% in the conventional treatment group underwent either elective or urgent surgery due to symptom onset during the follow-up period. The researchers noted that there was no operative mortality among subjects who underwent early or late surgery.

A subsequent intention-to-treat analysis comprised of all patients showed that 1.4% of 73 patients assigned to early surgery and 15.3% of 72 patients assigned to conventional treatment died from CV causes. Overall, the rate of the primary end point was 1.4% at four and eight years in the early surgery group juxtaposed with 5.7% at four years and 25.5% at eight years in the conventional treatment group with a total of five all-cause mortalities occurring in the early surgery group and 15 occurred in the conventional treatment group.

“Among asymptomatic patients with severe AS, the rates of the composite of operative or CV death, and death from any cause were significantly lower with early surgery than with conventional treatment,” the researchers wrote of the results.