A new study is challenging the current "watch-and-wait" approach for patients with asymptomatic severe aortic stenosis, a condition that narrows the heart valve controlling blood flow from the heart. Research published in the New England Journal of Medicine suggests that patients who undergo early valve replacement via a minimally invasive procedure experience better outcomes, including fewer hospitalizations and complications.

The findings indicate that replacing failing heart valves before symptoms arise can significantly reduce risks. Patients who underwent early transcatheter aortic valve replacement (TAVR)—a less invasive surgery where the valve is threaded through the groin up to the heart—had a 50% reduction in unplanned hospitalizations for heart issues over two years compared to those who were monitored without intervention. Death rates were slightly lower in the early surgery group (8.4%) versus those in clinical surveillance (9.2%), with notable reductions in stroke (4.2% versus 6.7%) and unplanned cardiovascular hospitalizations (20.9% versus 41.7%).

Dr. Gregg Stone, a cardiology professor at Mount Sinai said that the findings could reshape treatment strategies. “You may be able to at least prevent that progression and perhaps improve patient outcomes by treating earlier,” he said, calling it a significant shift for clinical practice.

For years, cardiologists have often delayed valve replacement until patients showed symptoms, largely due to the high risks associated with open-heart surgery. However, TAVR offers a less risky alternative, enabling earlier intervention without the challenges of traditional surgery. This study, led by Dr. Philippe Généreux of Morristown Medical Center, recruited around 900 patients with severe aortic stenosis who could pass a treadmill stress test. Half of the participants received early TAVR surgery, while the rest were monitored under standard care.

The trial revealed that over 40% of those in the wait-and-see group were hospitalized unexpectedly for heart-related issues, compared to only about 20% of those who had early surgery. Additionally, roughly 70% of those on conservative monitoring eventually needed surgery within two years, underscoring the disease’s rapid progression.

“This study shows that going earlier avoids bad things happening, especially ending up in the hospital,” said Dr. Toby Rogers, an interventional cardiologist at MedStar Washington Hospital Center, highlighting how the new findings will shift conversations between cardiologists and patients. While the durability of replacement valves and optimal timing for younger patients are still under investigation, the study paves the way for potentially transformative changes in managing severe aortic stenosis.