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Heart Failure With Preserved Ejection Fraction in the Young Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial Economic and Quality-of-Life Outcomes of Natriuretic Peptide–Guided Therapy for Heart Failure Non-obstructive High-Risk Plaques Increase the Risk of Future Culprit Lesions Comparable to Obstructive Plaques Without High-Risk Features: The ICONIC Study Use of Intravascular Ultrasound Imaging in Percutaneous Coronary Intervention to Treat Left Main Coronary Artery Disease Patient Selection and Clinical Outcomes in the STOPDAPT-2 Trial: An All-Comer Single-Center Registry During the Enrollment Period of the STOPDAPT-2 Randomized Controlled Trial Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study

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 . . .