Early Surgical Repair of Severe Aortic Stenosis Improves Mortality

Background: Guidelines currently recommend surgical repair for severe aortic stenosis if symptomatic, but “watchful waiting” if asymptomatic. The Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis (RECOVERY) trial showed a mortality benefit at 4 years for early surgical aortic-valve replacement in asymptomatic patients. Objective: To further elucidate the long-term outcomes of early surgical aortic-valve replacement as compared to conservative care, the final results of the RECOVERY trial are reported, with an extended follow-up of >10 years. Design: Multicenter, randomized open-label trial. Participants: Asymptomatic adults with very severe aortic stenosis (aortic-valve area of <0.75 cm 2 and peak aortic jet velocity of >4.5 m/s). Patients were randomized 1:1 to either early surgery (within 2 months) or conservative care (with surgery referral if they became symptomatic). The primary endpoint was a composite of operative mort more...