Table 3

Estimates of clinical risks associated with watchful waiting or early intervention strategies 

Risks associated with watchful waitingRisk estimateRisks associated with early interventionRisk estimate
Sudden cardiac death1.0%–1.5% per year
46–48 		Perioperative mortality1%–3%
(refine using validated risk calculator)
Death while awaiting elective intervention once symptoms develop4% at 1 month, 12% at 6 months
49 		Perioperative complications (SAVR):

  • Stroke.

  • Pacemaker requirement.

  • Major bleeding.

  • New atrial fibrillation.

­
2.4%–8.1%33–35
1.5%–8.6%32
9%–26%36 39
17%–43%34 36 39
Increased perioperative mortality:

  • Impaired left ventricular function.

  • No contractile reserve.

(Refine using validated risk calculator)
9%–19%10 20 50
22%–32%11 52 		Periprocedural complications (TAVI):

  • Stroke.

  • Pacemaker requirement.

  • Major vascular complications.

  • Major bleeding.

  • New atrial fibrillation.

­
2.2%–2.6%.40
7%–25%38–40
2.0%–4.5%40
12%–15%36 39
10%–13%34 36 39
Lack of improvement in ejection fraction following intervention25%–50%10 11 Long-term prosthetic valve complications:

  • Thromboembolism.

  • Major bleeding with anticoagulation.

­
0.7%–1.0% per year42
1.8%–2.6% per year42
Incomplete resolution of symptomsApproximately 50%50 Prosthetic valve endocarditis1%–3% in first year then <0.5% per year43
Increased late postintervention mortality:

  • Impaired ejection fraction.

  • Myocardial fibrosis.

HR 2.020
HR 1.25–5.2521 51 57 		Reoperation for structural valve degeneration:

  • <65 years of age.

  • >65 years of age.

­
­
46%–55% at 20 years
8%–15% at 20 years45

  • SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.