Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis at 10 Years

In this article, the authors present the 10-year follow–up of the RECOVERY trial involving 145 asymptomatic patients with very severe aortic stenosis, comparing early surgical aortic valve replacement with conservative care. Early surgery significantly reduced the primary composite endpoint of operative mortality or cardiovascular death vs conservative care (3 percent vs 24 percent; hazard ratio [HR] 0.10, 95 percent confidence interval [CI] 0.02 to 0.43; P=0.002). All-cause mortality was also lower with early surgery (15 percent vs 32 percent; HR 0.42, 95 percent CI 0.21 to 0.86). In addition, no patients in the early surgery group were hospitalized for heart failure, whereas 19 percent of those in the conservative care group were. These data support the option of early surgery in carefully selected low–risk asymptomatic patients with very severe aortic stenosis.