Name:
Aortic Stenosis and the Asymptomatic Patient
Description:
Aortic Stenosis and the Asymptomatic Patient
Thumbnail URL:
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Duration:
T00H03M12S
Embed URL:
https://stream.cadmore.media/player/1a2a69b4-b5c1-4647-aa8d-bc8d84f1f62f
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/1a2a69b4-b5c1-4647-aa8d-bc8d84f1f62f/18770272.mp3?sv=2019-02-02&sr=c&sig=iErnINpZZneciAK1zB%2FzOAfwO0MgLWfs9PoHymeSAE8%3D&st=2024-12-22T05%3A25%3A50Z&se=2024-12-22T07%3A30%3A50Z&sp=r
Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board review, and other online resources available only through accesscardiology.com. [ Music ] >> What to do with a patient with very severe aortic stenosis who's asymptomatic? Is watchful waiting still the way to go? Or is surgery done earlier in these asymptomatic patients associated with better outcomes? [ Music ] >> Dr. Bernie here, and welcome to Practice Impact Extra.
I want to discuss the recovery trial. The goal of this trial was to assess early surgery versus conventional treatment in very severe aortic stenosis. During my fellowship, I was brought up with the concept that severe asymptomatic aortic stenosis was associated with a very low one-year mortality. Currently, the AHA and ACC guidelines state that surgery is -- in a -- the asymptomatic patient with severe aortic stenosis has a Class 2B indication.
Yet there have been certainly observational studies suggesting a benefit of early surgical intervention. So the recovery trial was presented in November 2019 at the American Heart Association meeting, and this was a randomized trial of 145 patients with severe aortic stenosis but no symptoms. They were asymptomatic. And they were enrolled in this trial and followed for a duration of 6.2 years. The primary outcome was operative mortality and CV mortality at eight years.
The results indicated a 1% surgical group operative and CV [inaudible] years compared to a 15% in the watchful waiting group. The secondary endpoints of all-cause mortality, heart failure, hospitalizations, were all significantly reduced as well. So what's my take? As a practicing cardiologist, this trial has some other and some other observational studies, note that the majority of asymptomatic, very severe aortic stenosis patients come to a surgical endpoint within a very short period of time.
The results of early surgery group demonstrates significant improved survival out to eight years, compared with watchful waiting. [ Music ] Just one cautionary note. This surgical outcome study cannot be extrapolated to the TAVR group at this time. Trials of TAVR for asymptomatic aortic stenosis are enrolling patients presently. Again, thanks for joining me, and see you next time on Practice Impact Extra.
>> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
