Tomohiko Taniguchi, Takeshi Kimura
What was your rationale for this study and what was known before?
Surgical aortic valve replacement (AVR) is strongly recommended in symptomatic patients with severe aortic stenosis (AS) who are suitable candidates for surgery. However, the management of asymptomatic patients with severe AS remains controversial. A strategy of watchful waiting is generally recommended other than in several subgroups of patients, for example those with left ventricular dysfunction or very severe AS. However, this recommendation was based on previous small, single-centre studies evaluating symptoms and/or AVR, but not mortality as outcome measures.
What is unique about this study in your country?
To the best of our knowledge this is the first large-scale multicentre study comparing the long-term outcome of the initial AVR strategy versus the conservative strategy following the diagnosis of asymptomatic severe AS.