Surgical treatment of asymptomatic severe aortic stenosis(AS) is gaining attention following the results of RECOVERY and AVATAR trials showed survival benefits with early surgical aortic valve replacement(SAVR). We analyzed the long-term clinical/echocardiographic outcomes of SAVR in asymptomatic severe AS.
Between 2002-2020, 272 patients with asymptomatic severe AS and left ventricular ejection fraction≥50% underwent SAVR with/without concomitant aortic surgery and met the study criteria. Median follow-up was 8.5 years(IQR:6,12.8) for a total of 2584 patient-years. The time-course of left ventricular mass index(LVMI) and average E/E’, were assessed using 594 postoperative echocardiograms. The association of preoperative LVMI and average E/E’ with survival was assessed using Cox proportional hazards.
There was no operative mortality. On longitudinal analyses, LVMI improved in patients who were presented with moderate/severe preoperative left ventricular hypertrophy(LVH). However, following the early decline in the average E/E’, there was late increase to greater than upper limit normal, particularly in patients with preoperative average E/E’≥14. Postoperative Survival was 100%, 94%, 84%, and 76% at 1-, 5-, 10-, and 15-years comparable to age and sex-matched expected survival based on the US general population. On adjusted Cox survival analysis, only moderate-severe LVH was associated with a survival penalty[HR:2.32(CI:1.02-5.27,P=0.045)].
In asymptomatic AS patients, SAVR restores survival and improves LVH, but patients with diastolic dysfunction are left with persistent dysfunction. Presentation with moderate/severe LVH at the time of surgery translated to survival penalty. This observational study supports early SAVR in this population before development of LVH, although further investigation is needed.

Copyright © 2023. Published by Elsevier Inc.