AHA 2021 | AVATAR: Early Intervention in Asymptomatic Aortic Stenosis

Early surgical aortic valve replacement (SAVR) in patients with severe asymptomatic aortic stenosis can be beneficial in selected patients vs. waiting for symptoms. 

AHA 2021 | AVATAR: intervención precoz en estenosis aórtica asintomática

Severe AS in patients with no symptoms and conserved ventricular function raises few questions, clinically speaking. However, there is little evidence in favor of early intervention vs. close observation. 

The best data we had so far was brought by the RECOVERY study presented at that same meeting in 2019. With 145 patients randomized to early intervention vs. conventional strategy, this study found early SAVR in asymptomatic patients with severe aortic stenosis had lower risk of cardiovascular death at 6 years. 

The AVATAR included 157 patients between 2015 and 2020. Severe stenosis was defined as peak velocity > 4 m/seg, mean gradient > 40 mmHg and area < 1 cm2.

A mechanical valve was implanted in 53% of the 72 patients undergoing early SAVR (mean age 67).

Of all patients randomized to a conservative strategy, 25 required surgery: for symptom development (60%), stenosis progression (16%), ventricular function dropping below 50% (4%) or a combination of these factors (20%). Mean time from randomization to surgery was 400 días. 


Read also: TAVR vs Sutureless Surgical Aortic Valve Replacement in Low-Risk Patients.


After close to 3 years, the combined end point resulted 15.2% in the early intervention group vs 34.7% in the conservative group. All cause death and cardiac failure were responsible for tilting the scales in favor of early intervention. 

According to this study’s authors, the valve should be intervened when AS meets the severity criteria, regardless of symptoms.

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Original Title: Aortic valve replacement versus conservative treatment in asymptomatic severe aortic stenosis.

Reference: Banovic M et al. Presentado en las sesiones científicas del congreso AHA 2021 y publicado simultáneamente en Circulation. 2021 Nov 13. Online ahead of print. doi: 10.1161/CIRCULATIONAHA.121.057639.


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