Heart valve replacement surgery should be done earlier than planned for people with aortic stenosis – according to new research from the University of East Anglia.
The condition is one of the most common and serious valve disease problems, caused by a narrowing of the opening of the aortic valve.
Once patients develop symptoms such as shortness of breath, chest pain, or blackouts, guidelines recommend replacing the narrowed valve. But many patients with aortic stenosis have no symptoms even when they have severe valve narrowing and are therefore not eligible for valve replacement.
New research published today shows that these patients would benefit from valve replacement – before they suffer irreversible damage to the heart muscle.
Lead researcher Professor Vassilios Vassiliou, from UEA’s Norwich Medical School, said: “The heart has four valves, which allow blood to flow efficiently in one direction. With age, one of the valves , the aortic valve, becomes increasingly narrowed or ‘stenotic’.
“Many patients with severe aortic stenosis have no symptoms and are therefore not eligible for valve replacement under current guidelines.
“For those patients without symptoms, the guidelines suggest a ‘watchful waiting’ approach and intervention is only recommended when they have symptoms or develop pump failure.
“We wanted to know if it would be better to perform surgery and replace the valve as soon as possible.”
The research team performed a systematic review and meta-analysis, comparing early intervention with conservative management in patients with severe asymptomatic aortic stenosis.
They then analyzed data from all available studies involving a total of 3798 patients, of whom 302 were included in the two largest randomized controlled trials and 3496 in observational studies.
Professor Vassiliou said: “We found that early intervention, before patients show symptoms, is associated with a lower risk of death and hospitalization for heart failure.
“By the time patients develop symptoms, there has likely been irreversible damage to the heart muscle. This in turn may prevent a poorer prognosis and adverse outcomes even after successful intervention.
“The timing of aortic valve surgery is crucial.
“We hope that our findings may herald the start of a change in the management of patients with aortic stenosis, allowing surgery to take place more frequently while patients are asymptomatic.
“Ongoing trials in this high-risk population should shed more light on the issue and on identifying the optimal timing for intervention,” he added.
The research was carried out in collaboration with the University of Cambridge, University of Edinburgh, Norfolk and Norwich University Hospital, West Suffolk Hospital, Royal Brompton and Harefield Hospitals, Imperial College London and the University of Leicester. It was partly funded by the Wellcome Trust.
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