Outcomes Research in Review

Timing of Surgery in Patients With Asymptomatic Severe Aortic Stenosis

Kang D, Park S, Lee S, et al. Early surgery or conservative care for asymptomatic aortic stenosis. N Engl J Med. 2020;382:111-119.


 

References

Study Overview

Objective. To determine the timing of surgical intervention in asymptomatic patients with severe aortic stenosis.

Design. Open-label, multicenter, randomized controlled study.

Setting and participants. A total of 145 asymptomatic patients with very severe aortic stenosis were randomly assigned to early surgery or conservative care.

Main outcome measures. The primary endpoint was a composite of operative mortality or death from a cardiovascular cause during follow-up. The major secondary endpoint was death from any cause during follow-up.

Main results. The primary endpoint occurred in 1 of 73 patients (1%) in the early surgery group and 11 of 72 patients (15%) in the conservative care group (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01-0.67, P = 0.003). The secondary endpoint occurred in 7% of patients in the early surgery group and 21% of patients in the conservative care group (HR, 0.33; 95% CI, 0.12-0.90).

Conclusion. Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during follow-up was significantly lower among those who underwent early valve replacement surgery compared to those who received conservative care.

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