Contemporary approach and key considerations to asymptomatic aortic stenosis treatment

INTRODUCTION: Aortic stenosis is the most common and the deadliest valvular disease. The treatment of asymptomatic patients with severe AS is still a subject of investigation. Recently, ESC/EACTS guidelines for valvular diseases introduced a new indication for the treatment of asymptomatic low-risk patients with isolated high-gradient severe AS, as an alternative to clinical surveillance. AREA COVERED: This paper attempts to provide a rational, clinically-oriented and evidence-based approach to the treatment of asymptomatic patients with high-gradient severe AS without additional adverse factors such as decrease in left ventricular systolic function or increase in natriuretic peptides. We searched for original and review papers through the PubMed database using the key words: aortic stenosis, asymptomatic, risk stratification and intervention while not limiting the time period of analyzed papers. EXPERT OPINION: The latest ESC/EACTS recommendations for the treatment of asymptomatic AS should be considered adequate. Considering differences in patient characteristics and heterogeneous treatment modalities, as well as differences in institutional-level outcomes, the optimal intervention strategy still needs clarification. Ongoing trials in asymptomatic patients with severe AS should provide significant new evidence. The diverse array of therapeutic options emphasizes the need for TAVI vs. SAVR randomized trial in middle-aged asymptomatic patients.