Decision Making for Patients with Asymptomatic Severe Aortic Stenosis The Case for Preemptive Aortic Valve Replacement Surgery

Aortic stenosis disease typically progresses from mild to severe as patients age beyond 50, during which time patients are generally asymptomatic and their quality of life will remain similar to that of the general population. Most patients with Asymptomatic Severe Aortic Stenosis (ASAS) will develop one or more symptoms of angina, dyspnea, or syncope within five years. As there is no medicinal cure for the disease, these newly symptomatic patients will require Aortic Valve Replacement (AVR) surgery soon after onset of symptoms because without it 75% of them will die within three years from the first symptoms onset. The proper treatment of ASAS patients before they become symptomatic is subject to debate. The American College of Cardiology and American Heart Association (ACC/AHA) recommend "watchful waiting" for the onset of symptoms after which they recommend AVR surgery. Review of results of studies based on recently improved surgical outcomes indicate that preemptive AVR surgery before onset of symptoms produces vastly improved survivability compared to the watchful-waiting protocol. ACC/AHA guidelines for treatment of severe aortic stenosis accordingly should be modified to reflect this new reality by recommending early AVR surgery in place of watchful waiting for most all ASAS patients.