Aortic valve replacement vs. conservative treatment in asymptomatic severe aortic stenosis: long-term follow-up of the AVATAR trial

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F24%3A00085170" target="_blank" >RIV/00023001:_____/24:00085170 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11150/24:10488197

Result on the web

<a href="https://academic.oup.com/eurheartj/article/45/42/4526/7742145" target="_blank" >https://academic.oup.com/eurheartj/article/45/42/4526/7742145</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1093/eurheartj/ehae585" target="_blank" >10.1093/eurheartj/ehae585</a>

Result language

angličtina

Original language name

Aortic valve replacement vs. conservative treatment in asymptomatic severe aortic stenosis: long-term follow-up of the AVATAR trial

Original language description

Background and Aims The question of when and how to treat truly asymptomatic patients with severe aortic stenosis (AS) and normal left ventricular (LV) systolic function is still subject to debate and ongoing research. Here, the results of extended follow-up of the AVATAR trial are reported (NCT02436655, ClinicalTrials.gov).Methods The AVATAR trial randomly assigned patients with severe, asymptomatic AS and LV ejection fraction &gt;= 50% to undergo either early surgical aortic valve replacement (AVR) or conservative treatment with watchful waiting strategy. All patients had negative exercise stress testing. The primary hypothesis was that early AVR will reduce a primary composite endpoint comprising all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure (HF), as compared with conservative treatment strategy.Results A total of 157 low-risk patients (mean age 67 years, 57% men, mean Society of Thoracic Surgeons score 1.7%) were randomly allocated to either the early AVR group (n = 78) or the conservative treatment group (n = 79). In an intention-to-treat analysis, after a median follow-up of 63 months, the primary composite endpoint outcome event occurred in 18/78 patients (23.1%) in the early surgery group and in 37/79 patients (46.8%) in the conservative treatment group [hazard ratio (HR) early surgery vs. conservative treatment 0.42; 95% confidence interval (CI) 0.24-0.73, P = .002]. The Kaplan-Meier estimates for individual endpoints of all-cause death and HF hospitalization were significantly lower in the early surgery compared with the conservative group (HR 0.44; 95% CI 0.23-0.85, P = .012, for all-cause death and HR 0.21; 95% CI 0.06-0.73, P = .007, for HF hospitalizations).Conclusions The extended follow-up of the AVATAR trial demonstrates better clinical outcomes with early surgical AVR in truly asymptomatic patients with severe AS and normal LV ejection fraction compared with patients treated with conservative management on watchful waiting. Structured Graphical Abstract The design and main result of the AVATAR randomized trial (intention-to-treat population). AMI, acute myocardial infarction; CI, confidence interval; HF, heart failure; HR, hazard ratio; LV, left ventricular.

Czech name

—

Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2024

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

European heart journal

ISSN

0195-668X

e-ISSN

1522-9645

Volume of the periodical

2024

Issue of the periodical within the volume

45

Country of publishing house

GB - UNITED KINGDOM

Number of pages

10

Pages from-to

"4526–4535"

UT code for WoS article

001314558900001

EID of the result in the Scopus database

2-s2.0-85208772789