Asymptomatic Severe Aortic Stenosis: Early Intervention in Perspective

Severe aortic stenosis (sAS) is a relentless disease, which carries significant morbidity and mortality. Definitive treatment of sAS in the form of aortic valve replacement (AVR) mostly revolves around the presence of symptoms. Last decade has witnessed a surge in observational data suggesting asymptomatic sAS associated with higher cardiovascular events than what was previously appreciated. While society guidelines endorse early AVR in a selected subgroup of asymptomatic sAS patients, the majority are still managed with traditional “watchful-waiting” approach. This article reviews the available literature on the natural history of asymptomatic sAS, associated risk modifiers, and identify patients who are at high-risk for future clinical events to offer them preemptive valve placement therapy.