Is valve replacement indicated in asymptomatic patients with aortic stenosis or aortic regurgitation?

With rare exceptions, aortic valve replacement should be performed in all symptomatic patients with hemodynamically significant aortic stenosis; however, the asymptomatic patient requires a difficult risk-benefit analysis. In most asymptomatic patients the risks of aortic valve replacement outweigh the risks of conservative therapy and careful follow-up. Symptomatic patients with chronic aortic regurgitation should undergo aortic valve replacement. Asymptomatic patients with normal left ventricular function are not surgical candidates, but aortic valve replacement should be performed in most patients with reliable evidence for left ventricle dysfunction, even if symptoms are not yet present.