Trial Supports Early Valve Surgery in Asymptomatic Severe Aortic Stenosis

A new study, the Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis (AVATAR) trial, determined that early aortic valve replacement surgery appears to reduce the risk of death, heart attack, stroke, and heart failure, even for patients with severe aortic stenosis who are asymptomatic or do not need symptom relief. The study’s findings were presented at the American Heart Association’s Scientific Sessions 2021.


Lead study author, Marko Banovic, MD, PhD, associate professor of cardiology at University Clinical Center of Serbia and the University of Belgrade Medical School in Serbia, proposed the potential need for earlier surgical intervention given the fact that, “sustained pressure overload of the left heart chamber in severe aortic stenosis during a watchful waiting period is associated with structural and functional cardiac impairment.”


A total of 157 participants with an average age of 67 years were enrolled in the study at nine centers across seven European countries. All participants had no symptoms associated with severe aortic stenosis and no significant health conditions such as severe lung disease, chronic kidney disease, or high surgical risk. Patients were randomized to either an early surgery group (78 patients) or a conservative, non-surgical watchful waiting group (79 patients), in accordance with current treatment guidelines for asymptomatic patients.


Seventy-two participants received the early aortic valve replacement surgery. After an average follow-up of 32 months, they displayed lower rates of combined death, heart attack, stroke, or unplanned hospitalization for heart failure, as compared to the watchful waiting group. Thirteen patients in the early surgery group experienced one or more cardiac issues versus 26 in the non-surgical treatment group.


Dr. Banovic concluded that their results “deliver the additional degree of evidence needed to support the decision for early surgery and reassure a clinician when caring for a patient with severe asymptomatic aortic stenosis and normal left ventricular function. In such cases of low surgical risk and absence of other major health conditions, one may advocate for an early surgery for select patients.”