Early SAVR in asymptomatic heart patients linked to long-term benefits
Early surgical aortic valve replacement (SAVR) is associated with significant long-term benefits for asymptomatic patients presenting with severe aortic stenosis, according to new data published in The New England Journal of Medicine.[1]
“Current guidelines recommend aortic-valve replacement for symptomatic patients with severe aortic stenosis,” wrote first author Duk-Hyun Kang, MD, PhD, a cardiologist with the Asan Medical Center Heart Institute in South Korea, and colleagues. “For asymptomatic severe aortic stenosis, watchful waiting has been recommended with prompt intervention at symptom onset, given that the rate of sudden death during the asymptomatic phase is low (<1% per year). However, clinical trials have challenged the appropriateness of conservative management in such patients, showing a very low procedural risk of aortic valve replacement with a periprocedural mortality of less than 0.5% and a survival benefit with early preemptive aortic valve replacement as compared with conservative management.”
However, the authors explained, long-term data on early SAVR has remained limited. To help change that, the group shared 10-year data from RECOVERY, a randomized trial comparing early SAVR with watchful waiting in nearly 150 patients with very severe aortic stenosis. While 73 patients with a mean age of 65 years old underwent early SAVR, 72 patients with a mean age of 63.4 years old underwent conservative monitoring instead.
Overall, after 10 years, operative mortality or death from cardiovascular causes occurred in 1% of SAVR patients and 19% of watching waiting patients. All-cause mortality rates after 10 years, meanwhile, were 15% for the early SAVR patients and 32% for the watching waiting patients.
Kang et al. did note that waiting for patients to become symptomatic “remains a justifiable strategy” when it comes to treating severe aortic stenosis. When early treatment is linked to the benefits identified in this analysis, however, it becomes clear why some care teams may wish to consider treating the patient’s aortic stenosis earlier than later.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.