Çelik, Mevlüt Milojević, Milan Durko, Andras P. Oei, Frans B. S. Mahtab, Edris A. F. Bogers, Ad J. J. C. 2021 Journal of cardiovascular development and disease 8(4) Asymptomatic patients with severe aortic stenosis and the impact of intervention eng https://unilib.phaidrabg.rs/o:3160 doi:10.3390/jcdd8040035 cobiss:128518665 ISSN: 2308-3425 http://creativecommons.org/licenses/by/4.0/legalcode Key words: aortic valve replacement, aortic stenosis, asymptomatic, early surgery, watchful waiting application/pdf 730138 bytes info:eu-repo/semantics/article ABSTRACT: Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. METHODS: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). CONCLUSIONS: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.