Should We Reappraise Surgical Indications in Asymptomatic Severe High-Gradient Aortic Stenosis?

The optimal timing of aortic valve replacement in patients with severe aortic stenosis is not widely agreed upon. On the basis of retrospective autopsy data, it is generally believed that the prognosis of patients with no or minimal symptoms is relatively benign and that surgery can be safely delayed until symptoms develop (1). Accordingly, both the American Heart Association (AHA) and American College of Cardiology (ACC) and the European Society of Cardiology (ESC) guidelines consider symptomatic severe aortic stenosis as a class 1 indication for valve replacement but remain quite hesitant as to the optimal strategy to be adopted in asymptomatic patients [...