When should patients receive surgery for valve disease?

The Early surgery in severe ASYmptomatic Aortic Stenosis trial- EASY-AS.

Professor Gerald McCann at the University of Leicester is investigating the best time for people with aortic valve narrowing to have surgery. Aortic stenosis (AS) is a common condition where the aortic valve becomes progressively narrowed. It can take years for people with severe AS to develop symptoms, which include shortness of breath and chest pain. Some may never develop symptoms, but even those without symptoms may still be at risk of heart failure or death. When people have symptoms, surgery to replace the aortic valve is a good treatment but, as with any major surgery, there is a risk of complications and a long recovery process. Doctors therefore consider whether they should only offer surgery to those with severe AS, or wait until symptoms develop to avoid unnecessary major surgery. The EASY-AS trial will find out whether early surgery in people with severe AS but no symptoms leads to better outcomes after 5 years, compared with only operating once symptoms develop. The team will randomly assign 1170 people with severe AS and no symptoms into two groups: one group will have immediate surgery and the other group will only have the narrowed valve replaced once they develop symptoms. The trial will show whether having early surgery reduces the risk of death or hospitalisation from heart failure due to AS. The results could lead to new clinical guidance on how best to treat people with the condition.