Earlier aortic valve replacement may lower heart failure risk

Replacing a narrowed aortic valve before it becomes severely obstructed may help cut heart failure events in some older adults, according to a randomized trial. The advantage was observed in patients with moderate narrowing who already had symptoms or other warning signs of higher risk.

The aortic valve opens to allow blood to move from the heart to the rest of the body. When the valve opening becomes too tight, the heart must work harder to pump blood through it, and that extra strain can gradually damage the heart.

People with moderate aortic stenosis are usually followed with routine checkups and heart ultrasound scans. This study examined whether some patients might benefit from getting a replacement valve sooner.

The international trial included 744 patients, with an average age of 78. All had at least one factor associated with poorer outcomes or faster progression, such as symptoms or changes in heart structure or function.

Roughly half the participants were assigned to receive a valve replacement delivered through a tube placed into an artery in the groin. The rest were assigned to ongoing monitoring, with treatment still available if their condition worsened enough to justify it.

After two years, an estimated 16.7% of the early-treatment group had died or experienced a heart failure event, compared with 23.9% in the monitoring group. That amounts to about seven fewer people per 100 over the study period.

Fewer heart failure events drove the difference. The estimated rate was 10.8% with early replacement versus 19.0% with monitoring, while the study did not find a reduction in deaths with earlier treatment.

The findings were published in The New England Journal of Medicine. Because the combined outcome included heart failure events with or without hospitalization, the result reflects more than hospital admissions alone.

Patients and clinicians were aware of which treatment strategy had been assigned. The valve manufacturer funded the study. Longer follow-up could help determine whether the benefit lasts and how earlier treatment affects care later on.

The results apply to patients with moderate narrowing who also show signs of higher risk. They do not answer whether an earlier procedure is worthwhile for people with moderate narrowing who feel well and have no other evidence of strain.

For the patients included in the trial, the study sharpens the decision-making question. Clinicians can weigh the risks of waiting against the risks of a procedure, with evidence that earlier replacement reduced heart failure events over two years in this selected group.