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VALVULAR DISEASE

Early aortic valve surgery reduces mortality

Asymptomatic patients with very severe aortic stenosis (AS) who undergo early surgical aortic valve replacement are less likely to die from the procedure or from cardiovascular causes than patients receiving conservative care. This finding from the RECOVERY trial, presented at the AHA Scientific Sessions 2019, supports the early intervention with aortic valve replacement surgery in asymptomatic patients with very severe AS.

“Although one-third to one-half of patients with severe [AS] are asymptomatic at the time of diagnosis, appropriate timing of intervention for these patients remains controversial,” explain the study investigators. The RECOVERY trial was a randomized, open-label study designed to compare the long-term outcomes of early aortic-valve replacement surgery with a conservative-care approach in asymptomatic patients with very severe AS. In total, 145 patients were enrolled and randomly assigned to early surgery (n = 73) or conservative care (n = 72). Aortic valve replacement surgery was successfully performed in all patients assigned to the early-surgery group, and no operative mortality was observed. Among the patients receiving conservative care, 74% underwent surgical or transcatheter aortic valve replacement during the follow-up period (a median of ~6 years for both groups).

In the intention-to-treat analysis, the primary end point (a composite of operative mortality and cardiovascular mortality) occurred in 1% of the early-surgery group and in 15% of the conservative-care group (HR 0.09, 95% CI 0.01–0.67, P = 0.003). Furthermore, the early-surgery group had a lower incidence of death from any cause than the conservative-care group (7% versus 21%).

Together, these findings indicate that earlier intervention is associated with better outcomes for asymptomatic patients with very severe AS. Whether early surgery can also benefit those with less severe AS remains to be determined.

References

Original article

  1. Kang, D.-H. et al. Early surgery or conservative care for asymptomatic aortic stenosis. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1912846 (2019)

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Correspondence to Karina Huynh.

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Huynh, K. Early aortic valve surgery reduces mortality. Nat Rev Cardiol 17, 72 (2020). https://doi.org/10.1038/s41569-019-0316-9

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