For years, cardiologists have taken a conservative approach to managing heart valve disease, especially for patients without symptoms.
Those with severe aortic stenosis, a condition that narrows the heart’s main valve, have typically been advised to monitor their health instead of opting for surgery. However, a new clinical trial may change this approach.
Published in The New England Journal of Medicine, the trial found that replacing failing valves right away could drastically reduce patients’ risk of hospitalization for heart issues over two years.
Researchers concluded that symptom-free patients with aortic stenosis—who historically would return for periodic imaging and symptom checks—benefit significantly from early surgery, potentially preventing severe deterioration and improving their overall prognosis.
Dr. Gregg Stone, a professor of medicine at Mount Sinai, commented on the trial’s findings, highlighting that immediate treatment may “improve patient outcomes by treating earlier.”
Although he was not directly involved in the study, Dr. Stone noted that these findings are likely to alter standard practice.
The study, led by Dr. Philippe Généreux at Morristown Medical Center in New Jersey, included 900 patients aged 65 and older with severe aortic stenosis. These patients were divided into two groups: one received early surgical intervention, while the other followed the traditional approach.
Only one in five patients who underwent early surgery experienced unexpected hospitalization, compared to over 40 percent of those on the wait-and-see plan.
Moreover, roughly 70 percent of the conservatively managed patients ended up requiring valve replacement within two years, underscoring the accelerated progression of the disease.
Previously, cardiologists hesitated to recommend surgery for asymptomatic patients due to the risks associated with open-heart surgery.
However, the advent of transcatheter aortic valve replacement (TAVR)—a minimally invasive technique—has allowed doctors to replace faulty valves by threading them through the groin, reducing surgical risks.
The trial found that performing TAVR early did not introduce additional risks compared to waiting for symptoms to appear.
These new insights will change how doctors discuss treatment options with their patients.
As Dr. Toby Rogers, an interventional cardiologist, explained, “Going earlier avoids bad things happening, especially ending up in the hospital.” He noted that TAVR could prevent the disease’s quick escalation, protecting patients from severe health complications.
While further studies are needed to examine the durability of replacement valves and the best options for younger patients, this trial suggests that early intervention offers substantial benefits for many individuals with severe aortic stenosis.
This shift from the traditional approach could mean better outcomes and fewer emergency hospital visits for patients nationwide.