Early Surgery Versus Conventional Treatment in Asymptomatic Very Severe Aortic Stenosis

Abstract

Background— The optimal timing of surgical intervention remains controversial in asymptomatic patients with very severe aortic stenosis. We therefore compared the long-term results of early surgery and a conventional treatment strategy. Methods and Results— From 1996 to 2006, we prospectively included a total of 197 consecutive asymptomatic patients (99 men; age, 63±12 years) with very severe aortic stenosis. Patients were excluded if they had angina, syncope, exertional dyspnea, ejection fraction 85 years. Very severe aortic stenosis was defined as a critical stenosis in the aortic valve area ≤0.75 cm2 accompanied by a peak aortic jet velocity ≥4.5 m/s or a mean transaortic pressure gradient ≥50 mm Hg on Doppler echocardiography. The primary end point was defined as the composite of operative mortality and cardiac death during follow-up. Early surgery was performed on 102 patients, and a conventional treatment strategy was used for 95 patients. There were ...