AVR for Asymptomatic Severe AS 13 Feb 2025. JAMA Cardiology
AVR for Asymptomatic Severe AS
13 Feb 2025. JAMA Cardiology .
Key Takeaways from the Article: Cardiologists Recommend AVR for Asymptomatic Severe AS
1. Default Treatment Recommendation:
• Experts propose that aortic valve replacement (AVR) should be the standard treatment for asymptomatic severe aortic stenosis (AS) instead of clinical surveillance (CS).
• Exceptions may apply due to anatomical or clinical factors.
2. TAVR vs. SAVR – Case-by-Case Decision:
• Both transcatheter AVR (TAVR) and surgical AVR (SAVR) can provide positive outcomes.
• The choice should be based on anatomical suitability, patient age, comorbidities, and personal preference.
3. Supporting Clinical Evidence:
• EARLY TAVR Trial:
• Included 901 patients (mean age: 75.8 years).
• TAVR significantly reduced the primary endpoint (death, stroke, or hospitalization) compared to CS (26.8% vs. 45.3%).
• AVATAR Trial:
• Included 157 low-risk patients (mean age: 67 years).
• Early SAVR led to better outcomes compared to conservative treatment (23.1% vs. 46.8% for primary endpoint).
4. Concerns About Valve Durability:
• While long-term durability of valves remains uncertain, early intervention is still recommended.
• The timing of a second procedure is likely similar, regardless of early AVR or CS strategy.
5. Addressing Public Health Concerns:
• Delayed or inadequate treatment of severe AS remains a major issue.
• Shifting to prompt AVR can improve patient outcomes and healthcare resource utilization.
6. Call to Action:
• Experts strongly advocate for a paradigm shift toward earlier AVR intervention.
• “It is time to act.”
