Phillip Genereux explains new insights in the EARLY TAVR trial at ACC25

A new analysis EARLY TAVR data presented at ACC.25 suggested that intervening before symptoms arise in asymptomatic severe aortic stenosis (AS) leads to better outcomes and lower stroke rates. The biggest takeaway was that 40% of patients who waited for symptoms to worsen before getting transcatheter aortic valve replacement (TAVR) rapidly declined without any warning. These patients were very difficult to manage due to cardiac arrest, heart failure hospitalization and pulmonary edema, and they were associated with elevated stroke rates. 

Cardiovascular Business spoke with the trial's principal investigator, Philippe Genereux, MD, director of the structural heart program at Morristown Medical Center, to find out more details.

The trial divided about 900 asymptomatic patients between early TAVR interventions and a second arm for traditional clinical monitoring. Outcomes showed early TAVR intervention was clearly superior for death, stroke and unplanned hospitalizations. Early data were presented at TCT 2024. This latest data from ACC.25, meanwhile, looks at the remaining patients in the clinical surveillance arm who have all crossed over since the initial trial data were presented. A handful of these patients were still asymptomatic when converted to TAVR, and the rest converted with progressive valve syndrome, or the most severe classified as acute valve syndrome, which Genereux said are the "crash and burn" worst-case patients.