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The ‘wait for symptoms’ strategy in asymptomatic severe aortic stenosis
  1. José Alberto San Román1,
  2. Isidre Vilacosta2,
  3. Manuel J Antunes3,
  4. Bernard Iung4,
  5. Javier Lopez1,
  6. Hans-Joachim Schäfers5
  1. 1 Cardiology, Hospital Clinico Universitario de Valladolid Servicio de Cardiologia, Valladolid, Spain
  2. 2 Cardiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
  3. 3 Cardiothoracic Surgery, Centro Hospitalar de Coimbra, Coimbra, Portugal
  4. 4 Cardiology, Hopital Bichat-Claude-Bernard, Paris, France
  5. 5 Klinik für Thorax- und Herz- Gefäßchirurgie, Universität des Saarlandes, Saarbrucken, Germany
  1. Correspondence to Dr José Alberto San Román, Cardiology, Hospital Clinico Universitario de Valladolid Servicio de Cardiologia, Valladolid, Spain; asanroman{at}


Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.

  • valve disease surgery
  • aortic stenosis

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  • Contributors All authors provided critical feedback and helped shape the research, analysis and the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.