According to a new study from the University of East Anglia, heart valve replacement surgery should be performed earlier than is commonly considered for people with aortic stenosis.
The disease is one of the most common and serious problems with the valve caused by narrowing of the aortic valve orifice.
If patients experience symptoms such as shortness of breath, chest pain, or darkening, the recommendations recommend replacing the narrowed valve. But many patients with aortic stenosis have no symptoms even with severe valve narrowing and are therefore not subject to valve replacement.
A new study published today shows that these patients will benefit from valve replacement – before they get irreversible damage to the heart muscle.
Lead researcher Professor Vassilios Vassiliou of UEA Medical School in Norwich said: “The heart has four valves that allow blood to flow efficiently in one direction. With age one of the valves, the aortic valve, becomes more narrowed or ‘stunted’.
“Many patients with severe aortic stenosis have no symptoms and therefore should not be replaced with a valve in accordance with current guidelines.
For these asymptomatic patients, the recommendations provide a “cautious wait” approach, and intervention is recommended only if they have symptoms or a pump failure.
“We wanted to know if it would be better to have surgery and replace the valve sooner than later.”
The research team conducted a systematic review and meta-analysis comparing early intervention and conservative treatment in patients with asymptomatic severe aortic stenosis.
They then analyzed data from all available studies involving a total of 3,798 patients, of whom 302 were included in the two largest randomized controlled trials and 3,496 in observational studies.
Professor Vasiliev said: “We found that early intervention, even before patients developed symptoms, was associated with a lower risk of death and hospitalization due to heart failure.
“As long as patients show symptoms, there is likely to be irreversible damage to the heart muscle. This, in turn, may rule out a worse prognosis and adverse outcomes even after a successful intervention.
“The timing of aortic valve intervention is crucial.
“We hope that our findings can herald the beginning of changes in the treatment of patients with aortic stenosis, which will allow for more frequent interventions while patients are asymptomatic.
“It is expected that the current tests to investigate this high-risk group will shed more light on this issue and in determining the optimal time to intervene,” he added.
The study was conducted in collaboration with Cambridge University, the University of Edinburgh, Norfolk and Norwich University Hospital, West Suffolk Hospital, Brompton and Harfield Royal Hospitals, Imperial College London and the University of Leicester. It was partly funded by the Wellcome Trust.
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