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Heart Failure With Improved Ejection Fraction-Is it Possible to Escape One’s Past? Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Bridging the Gap Between Epigenetic and Genetic in PAH Poor Long-Term Survival in Patients With Moderate Aortic Stenosis Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access? Percutaneous Atriotomy for Levoatrial–to–Coronary Sinus Shunting in Symptomatic Heart Failure: First-in-Human Experience Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement Aortic Valve Stenosis Treatment Disparities in the Underserved JACC Council Perspectives Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion

EditorialNovember 16, 2019

JOURNAL:N Engl J Med. Article Link

Timing of Intervention in Aortic Stenosis

P Lancellotti, MA Vannan. Keywords: asymptomatic patients with severe aortic stenosis; treatment timing

ABSTRACT


Current guidelines require that in patients with severe aortic stenosis, symptoms related to the valvular disease be present for consideration of transcatheter aortic-valve replacement (TAVR) or surgical aortic-valve replacement.  In the absence of symptoms, only very severe aortic stenosis is an indication (class IIa) for intervention. Kang et al. now report in the Journal the results of a trial involving patients with asymptomatic, very severe aortic stenosis who were randomly assigned to surgical aortic-valve replacement or conservative care (clinical follow-up and observation). Outcomes (death during or within 30 days after surgery [operative mortality] or death from cardiovascular causes; death from . . .