Cardiology, Hospital Clinico Universitario de Valladolid Servicio de Cardiologia, Valladolid, Spain
Cardiology, Hospital Clinico Universitario San Carlos, Madrid, Spain.
Heart. 2020 Dec;106(23):1792-1797. doi: 10.1136/heartjnl-2020-317323. Epub 2020 Aug 3.
Calcific aortic stenosis is a prevalent and worrisome healthcare problem. The therapeutic approach in asymptomatic aortic stenosis is not well established. We argue that the natural history of this disease is based on old incomplete studies with many limitations. Likewise, studies suggesting that replacement, either surgical or percutaneous, improves prognosis in asymptomatic patients with severe aortic stenosis have important drawbacks and do not support this strategy as the treatment of choice. Despite the lack of evidence, some groups recommend early valve replacement in patients with severe asymptomatic aortic stenosis. There are five ongoing randomised trials which will shed light on this topic. Our conclusion is that unless a randomised study changes the evidence, valve replacement cannot be recommended in asymptomatic patients with severe aortic stenosis.
钙化性主动脉瓣狭窄是一种普遍且令人担忧的医疗保健问题。在无症状主动脉瓣狭窄的治疗方法尚未得到很好的确立。我们认为，这种疾病的自然史是基于旧的、不完善的研究，存在许多局限性。同样，一些研究表明，无论是手术还是经皮置换，都可以改善严重主动脉瓣狭窄无症状患者的预后，但这些研究存在重要的缺陷，不能支持将这种策略作为首选治疗方法。尽管缺乏证据，一些团体仍建议对严重无症状主动脉瓣狭窄患者进行早期瓣膜置换。目前有五项正在进行的随机试验将对此问题进行研究。我们的结论是，除非随机研究改变证据，否则不能推荐在无症状的严重主动脉瓣狭窄患者中进行瓣膜置换。
