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August 24, 2026New England Journal of Medicine525 citationsOpen Access

Early Surgery Versus Conservative Care for Asymptomatic Severe Aortic Stenosis

Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

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Authors

DKDuk‐Hyun KangSPSung‐Ji ParkSLSeung‐Ah Lee

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Overview

Randomized trial demonstrates early surgery reduces cardiovascular death in asymptomatic very severe aortic stenosis, indicating timely intervention prevents fatal complications.

Key Points

  • To determine whether early surgical aortic-valve replacement improves clinical outcomes compared with guideline-directed conservative care in asymptomatic patients with very severe aortic stenosis.
  • Randomized clinical trial (RECOVERY trial, NCT01161732) assigning asymptomatic patients with very severe aortic stenosis (aortic jet velocity ≥4.5 m/s or mean transaortic gradient ≥50 mm Hg) to early surgery (N=73) or conservative care (N=72).
  • Assessed a primary composite end point of operative mortality (death during or within 30 days of surgery) or cardiovascular death during total follow-up, along with a secondary end point of all-cause mortality.
  • The primary end point occurred in 1 of 73 patients (1%) in the early-surgery group versus 11 of 72 patients (15%) in the conservative-care group (HR, 0.09; 95% CI, 0.01 to 0.67; P = 0.003).
  • Death from any cause occurred in 5 of 73 patients (7%) in the early-surgery group compared with 15 of 72 patients (21%) in the conservative-care group (HR, 0.33; 95% CI, 0.12 to 0.90).
  • Among early-surgery patients, 69 of 73 (95%) underwent surgery within 2 months with 0% operative mortality, whereas conservative-care patients experienced a cumulative sudden death incidence of 4% at 4 years and 14% at 8 years.

Cite This Study

Kang et al. (2019) studied this question.

synapsesocial.com/papers/6a8c4702c3c9940b1814615fhttps://doi.org/10.1056/nejmoa1912846
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