Patients either get a new valve years early or wait for symptoms.
The debate
8 clinicians quoted on the record
Refer for valve replacement at diagnosis. Randomized data show fewer deaths, strokes and hospitalizations than surveillance.
Wait until symptoms, a weakening ventricle or a failed exercise test appear, as guidelines direct.
Where the experts land
0–0 on record · 8 unplaced
Replace the valve at diagnosis · 0
On the record, unplaced · 8
Wait for symptoms or a weakening heart · 0
“The lack of convergence of the curves for death from cardiovascular causes and death from any causes over this prolonged period of follow-up underscores the sustained benefits of early surgery.”
Who we found publicly on the record — a snapshot, not a poll of the field. Larger dots are deciders; dashed dots are scan-reported, not yet verified.
Where the field stands
Common ground
Once symptoms appear or ejection fraction falls, the valve should be replaced.
The crux
Do we replace the valve now in a symptom-free patient, or keep watching?
Still unknown
Randomized benefit on death and stroke rather than hospitalization, in patients beyond the trial's anatomy and age profile — DANAVR reaches primary completion in September 2029.
On the record
Their own words — position stated as published
Early intervention
“The most important finding is there's no evidence of any penalty or harm of the strategy of early intervention. It seems that there's no advantages to wait.”
Philippe Généreux · Interventional cardiologist · X ↗
Early intervention
“The lack of convergence of the curves for death from cardiovascular causes and death from any causes over this prolonged period of follow-up underscores the sustained benefits of early surgery.”
Duk-Hyun Kang · Cardiologist · X ↗
Early intervention
“Overall findings advocate for early surgery once AS becomes significant, regardless of symptom status.”
Marko Banovic · Cardiologist · X ↗
“Intervening early isn't necessarily going to make you live longer because there's other things that come into play, but it can make you live better. It’s going to be an individualized discussion, because I think we should be offering early intervention to our patients.”
Marc R. Dweck · University of Edinburgh · X ↗
Where do you land?
No votes yet — the measured split appears at 10.
Where the evidence stands
What's settled
2What's still open
1How this gets settled
Resolving trial — not yet identified
Who could settle it
Know an expert who could settle this? Suggest one →
Who this affects
Who could fund or run it
Institutions that could fund, run, or adopt
Sources & verification
+ 17 more, each dated and verification-tagged