Early TAVR Procedure Significantly Lowers Cardiovascular Risks in Asymptomatic Aortic Stenosis Patients

Recent findings from the EARLY TAVR trial indicate that performing transcatheter aortic valve replacement (TAVR) at an earlier stage can significantly reduce the occurrence of cardiovascular events in patients diagnosed with asymptomatic aortic stenosis (AS). The results were unveiled during the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions.

Each year, approximately 300,000 individuals in the United States receive a diagnosis of aortic stenosis, a critical condition characterized by the narrowing or obstruction of the aortic valve in the heart. Traditionally, two management strategies have been employed for asymptomatic patients with severe AS: clinical surveillance (CS), which involves routine monitoring of symptoms, and surgical intervention via aortic valve replacement.

The latest analysis from the EARLY TAVR trial reveals that early intervention with TAVR is a more effective approach than clinical surveillance for patients with asymptomatic severe AS. This study marks the first report from a randomized controlled trial examining whether age should play a role in the timing of the procedure for this patient population.

The primary objectives of the research were to assess rates of mortality, stroke, and unplanned cardiovascular hospitalizations. A total of 901 patients with asymptomatic severe AS participated in the study, with 455 assigned to the early TAVR group and 446 to the CS group. The average follow-up duration was 3.8 years, and baseline health characteristics were comparable across both groups.

Findings from the trial indicated that older patients experienced increased rates of death, stroke, or heart failure hospitalizations over a five-year period, regardless of the treatment approach. Nevertheless, the early TAVR intervention displayed notable advantages across all age demographics.

Notably, patients aged 65 to 69 years who underwent early TAVR exhibited the most significant benefits, with a complete elimination of stroke risk (0% in the early TAVR cohort versus 13% in the CS group) and a substantially lower cumulative rate of death, stroke, or heart failure hospitalizations compared to those receiving clinical surveillance (4.7% vs. 25.6%, respectively) over the five-year follow-up period. Furthermore, patients aged over 80 also experienced considerable advantages in stroke risk reduction, with early TAVR associated with a fourfold decrease in stroke occurrences compared to those who underwent clinical surveillance.

The implications of these results underscore the importance of early intervention for younger patients with asymptomatic severe aortic stenosis, particularly concerning stroke risk, which is a significant concern for many patients. The research suggests that untreated aortic stenosis may serve as a critical risk factor for stroke.

Given the benefits observed in patients aged 65 and older and the minimal associated risks, early TAVR is recommended as a preferred treatment option over clinical surveillance across all age groups.