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Aortic valve replacement for severe but asymptomatic stenoses was associated with better long-term outcomes than "watchful waiting" for symptoms to develop, a Japanese registry suggested.
Such patients treated with the valve procedure initially had a lower cumulative 5-year incidence of all-cause mortality compared with initial conservative management (15.4% versus 26.4%, P=0.009), Takeshi Kimura, MD, of Kyoto University in Japan, and colleagues found.
The same was true for heart failure hospitalization (3.8% versus 19.9%, P<0.001), the researchers wrote online in the .
Both associations remained significant in multivariable and in propensity-score matched analyses.
And, "in the present study, 41% of patients managed conservatively required aortic valve replacement within a median follow-up of 2 years, suggesting that one does not gain much by waiting," Kimura's group noted.
Of their CURRENT AS registry's 3,815 consecutive patients with severe aortic stenosis (defined by a peak aortic jet velocity over 4.0 m/s, mean aortic pressure gradient over 40 mm Hg, or aortic valve area less than 1.0 cm2), 1,808 were asymptomatic.
Most asymptomatic patients were conservatively managed (1,517 of the 1,808), and nearly all of the rest got surgical aortic valve replacement.
"The extent of benefits appeared to be similar regardless of the current indications for aortic valve replacement, such as left ventricular dysfunction or very severe aortic stenosis," the researchers noted.
They acknowledged that ascertaining symptom status can be a challenge, because often patients "may not complain [of] any symptoms because of their sedentary lifestyle."
Another challenge is that patients aren't always compliant with the watchful part of watchful waiting, they added.
"Indeed in the current study, severe heart failure was the initial symptom in a sizable proportion of patients in the conservative group, in whom aortic valve replacement was less frequently performed than in patients without severe heart failure," Kimura's group wrote, "and mortality was extremely high if aortic valve replacement was not performed."
Along with the limitations of all registry studies, the researchers noted the possibility of ascertainment bias.
The study was presented at the Transcatheter Cardiovascular Therapeutics meeting in San Francisco along with the JACC publication.
From the American Heart Association:
Disclosures
The registry was funded by Kyoto University.
Kimura and co-authors disclosed no relevant relationships with industry.
Primary Source
Journal of the American College of Cardiology
Taniguchi T, et al "Initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis" JACC 2015; DOI: 10.1016/j.jacc.2015.10.001.