Highlights from

AHA 2019

American Heart Association’s Scientific Sessions

Philadelphia, USA 16 - 18 November 2019

RECOVERY: Benefit of Early Surgery in Asymptomatic Severe Aortic Stenosis

Results of the RECOVERY trial demonstrate that early pre-emptive aortic valve replacement (AVR) versus conservative management in asymptomatic patients with severe aortic stenosis (AS) significantly reduced the rates of operative or cardiovascular death, and death from any cause.

Prof. Duk-Hyun Kang (Asan Medical Center, South Korea) reported on the comparison of long-term outcomes of early surgery and conventional treatment in asymptomatic AS [1]. The timing of surgical intervention in this asymptomatic patient population has been controversial, as it was previously unclear whether the risk of death outweighed the risk of AVR. To date, the recommendation has been for watchful observance of these patients.

The Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis (RECOVERY) study is a prospective, multicentre, open-label, randomised trial in which asymptomatic patients with very severe AS were randomly assigned to early surgery (n=73) or to conventional treatment (n=72). The primary endpoint of the trial was a composite of operative mortality or cardiovascular death, and the major secondary end point was death from any cause.

Patients in the early surgery group received AVR within 2 months of randomisation (n=69, 73 were assigned), while patients in the conventional treatment arm were treated according to the current guidelines (n=52, 72 were randomised to this arm). They were referred for AVR if they became symptomatic, LVEF < 0.50, or an increase in peak aortic velocity > 0.5 m/s per year. One (1.4%) of 73 patients assigned to early surgery and 11 (15.3%) of 72 patients assigned to conventional treatment died from cardiovascular causes (HR 0.12; 95% CI 0.02-0.72; P=0.020) in the intention-to-treat analysis.

In the early surgery group, the rate of primary endpoint was 1.4% at 4 and 8 years follow-up compared with 5.7% at 4 years and 25.5% at 8 years in the conventional treatment arm (P=0.003 by log-rank test).

Five deaths from any cause (6.8%) were reported in the early surgery group compared with 15 (20.8%) in the conventional treatment group (HR 0.33; 95% CI 0.12-0.90; P=0.030), and the rate of death from any cause was higher in the conventional treatment arm compared with the early surgery group (9.7% vs 4.1% at 4 years and 31.8% vs 10.2% at 8 years, respectively; P=0.018 by log-rank test).

  1. Kang D-H, et al. RECOVERY: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis. Session LBS04. American Heart Association Annual Scientific Sessions (AHA 2019), 14-18 November, Philadelphia, PA, USA.

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