Great debate: symptomatic moderate aortic stenosis should undergo intervention
Aortic stenosis (AS) has become a major health burden with a reported prevalence of 2–6% in the population older than 65 years.1–3 Globally, 12.6 million patients with calcific AS—the most common aetiology of AS—have been estimated causing 102 700 deaths4 and the prevalence appears to increase rapidly with the aging population, particularly in Europe and North America.4,5 The dismal outcome of symptomatic severe AS was reported for the first time almost 60 years ago by Ross and Braunwald.6 The excellent outcome of this population after successful surgical aortic valve replacement (SAVR) has been demonstrated already 35 years ago.7 Although based only on observational data, the difference in survival was so striking that a randomized controlled trial (RCT) comparing surgery with conservative treatment would have been unethical and has therefore never been performed. The development of transcatheter aortic valve implantation (TAVI) however finally confirmed in an RCT including patients who were not eligible for SAVR that relief of AS by TAVI was followed by a dramatic survival improvement even in this very sick population.8
