Is It Reasonable to Treat Asymptomatic Severe Aortic Stenosis in 2025?
Is It Reasonable to Treat Asymptomatic Severe Aortic Stenosis in 2025?
Source: Medscape Cardiology، October 13, 2025
Keynotes:
1. Main Question: Should asymptomatic severe aortic stenosis (AS) be treated early, especially with TAVR?
2. Against (Dr. Mandrola):
• Evidence remains weak; small trials (RECOVERY, AVATAR, EVOLVED) show no mortality benefit.
• EARLY TAVR reduced hospitalizations, but mainly due to trial bias and crossover effects.
• Observation remains safe; early intervention does not meet the evidentiary threshold.
3. For (Dr. Cohen):
• Early TAVR may prevent sudden deterioration and reduce heart failure hospitalizations.
• Reasonable in older or high-risk patients, but still not Class I evidence.
4. Meta-Analysis:
• Combined data show no reduction in mortality or CV death, only fewer emergency admissions.
5. Guidelines (2025 Updates):
• US (2020): Class I — intervene only if LVEF < 50% or combined surgery is planned.
• Europe (2025): Class IIa — consider early intervention in patients with rapid progression, LV dysfunction, or very high gradient defined as:
• Peak aortic jet velocity (Vmax) ≥ 5.0 m/s, or
• Maximum pressure gradient (PGmax) ≥ 100 mmHg, or
• Mean gradient ≥ 60 mmHg.
6. Consensus:
• TAVR ≈ SAVR in 5-year outcomes for low-risk patients.
• Decisions should rely on Heart-Team assessment and shared decision-making.
7. Key Point:
• No proven survival benefit yet for early TAVR/SAVR in asymptomatic severe AS.
• Management should be individualized, emphasizing patient risk, anatomy, and access to timely care.
