A groundbreaking clinical trial could rewrite the rules for treating severe heart valve disease.
Early transcatheter aortic valve replacement was found to lower mortality, enhance quality of life and prevent disease progression in patients who have severe aortic stenosis, according to the study. The findings break with current guidelines, which recommend clinical surveillance every six to 12 months for patients without symptoms.
Watching and Waiting Puts Patients at Risk
Outperforming the traditional “watchful waiting” approach, early transcatheter aortic valve replacement was found to reduce the risk of complications and can improve overall heart function. Importantly, it also allowed patients to avoid the abrupt onset of symptoms, which can result in unplanned hospitalization or urgent surgery.
Undergoing valve replacement early introduced no new risks to patients who had the intervention, the study found; it also mitigated the risk of stroke.
Of the surveillance control group, 95.2% progressed to the point of needing surgery – and had it – within the following five years. Given this outcome, the trial provides evidence that it’s not a matter of if patients need the replacement surgery, but when it’s most beneficial.
Implications for Patient Care
The compelling trial results could fuel calls for updating treatment protocols for patients with severe aortic stenosis.
Even without official guidelines in place, cardiologists are increasingly considering early intervention and other proactive strategies for their patients. In addition to superior outcomes, adopting an early transcatheter aortic valve replacement approach, before patients face life-threatening symptoms, could reduce hospitalizations and save lives. Importantly, addressing health disparities in access to early intervention could ensure that historically underserved populations – who are disproportionately impacted by heart valve disease – benefit from these life-saving advancements.
Patients with asymptomatic severe aortic stenosis may benefit from earlier discussions about their treatment options. Both individual providers and those involved with the development of guidelines would be wise to weigh this new evidence that shows better patient outcomes.
