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Cited by 537Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesCongenital Heart Disease Studies

Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis

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Kang, Duk-Hyun, Park, Sung-Ji, Lee, Seung-Ah, Lee, Sahmin, Kim, Dae-Hee, Kim, Hyung-Kwan, Yun, Sung-Cheol, Hong, Geu-Ru +5 more·2020·New England Journal of Medicine
DOI 10.1056/nejmoa1912846
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Abstract

Background The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial. Methods In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm 2 with either an aortic jet velocity of ≥4.5 m per second or a mean transaortic gradient of ≥50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up. Results In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P = 0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years. Conclusions Among asymptomatic patients with…

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  • Finding patients with SHD earlier in the disease process reduces mortality, decreases costs and improves quality of life.

    “Finding patients with SHD earlier in the disease process has been shown to reduce mortality, decrease costs and improve quality of life, but getting to diagnosis remains challenging1,15,16.”

    From Detecting structural heart disease from electrocardiograms using AI (2025) · cites this paper as [15]

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Authors
Kang, D.-H., Park, S.-J., Lee, S.-A., Lee, S., Kim, D.-H., Kim, H.-K., Yun, S.-C., Hong, G.-R., Song, J.-M., Chung, C.-H., Song, J.-K., Lee, J.-W., & Park, S.-W.
Affiliations
  • Asan Medical Center (KR)
  • Severance Hospital (KR)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2020-01-09
Volume
382
Issue
2
Pages
111-119
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1912846
OpenAlex
W2986138421
Cited by
537
References
3
Citations by year
2026: 79 · 2025: 88 · 2024: 71 · 2023: 66 · 2022: 78 · 2021: 71 · 2020: 80 · 2019: 3
FWCI
41.91
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
Funders
Korean Institute of Medicine
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
Keywords
asymptomatic aortic stenosis, conservative treatment, timing of surgery, aortic jet velocity, aortic valve gradient, postoperative mortality, cardiovascular mortality, sudden death, aortic valve surgery
MeSH terms
Conservative Treatment, Aged, Aortic Valve, Aortic Valve Stenosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications, Incidence, Kaplan-Meier Estimate, Intention to Treat Analysis, Asymptomatic Diseases, Patient Acuity

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