Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation.

The benefits of early valve replacement in asymptomatic patients with severe aortic stenosis

“…Previously, some cardiologists advised ''cat-like observation'' for asymptomatic patients with severe AS because of the anticipated 2% to 3% yearly risk of prosthesis-and anticoagulant-related complications and the 1% yearly incidence of death after AVR. 8,9 However, when patients who had received an AVR in our series were compared with an ageand gender-matched Minnesota population, there was no difference in late survival, suggesting that the risk of aortic valve prostheses-related complications and death may be overestimated with the use of modern mechanical valves that require lower anticoagulation levels and bioprosthetic valves that have greater durability.…”

Long axis excursion in aortic stenosis

“…The outlook in asymptomatic aortic stenosis is widely regarded as too good to justify surgery3 although there is controversy about how frequently sudden death occurs. Furthermore, death can occur soon after the onset of symptoms,1 underlining the need for exceptionally careful follow up of asymptomatic patients 28. If a reliable method of predicting the onset of symptoms were available, this could guide the frequency of follow up.…”

Exercise testing to guide surgery in aortic stenosis

“…The conservative management of patients with asymptomatic severe aortic stenosis is acknowledged to require extreme vigilance16 particularly when a surgical waiting list may be months rather than weeks in length. The difference in prognosis between asymptomatic and symptomatic aortic stenosis is extreme and should not be left to subjective history taking alone.…”