Valvular & structural heart diseaseRandomised controlled trial
Aortic valve replacement vs. conservative treatment in asymptomatic severe aortic stenosis: long-term follow-up of the AVATAR trial
- Randomised controlled trial
- extended follow-up
Authors' conclusion
The extended follow-up of the AVATAR trial demonstrates better clinical outcomes with early surgical AVR in truly asymptomatic patients with severe AS and normal LV ejection fraction compared with patients treated with conservative management on watchful waiting.
Study context
- Population
- Asymptomatic severe aortic stenosis (AS) with LVEF ≥ 50% and negative exercise stress testing; low-risk (mean age 67 years, mean STS score 1.7%)
- Participants
- 157 participants
- Comparison
- Early surgical aortic valve replacement (AVR) vs conservative treatment
- Early AVRn = 78
- Conservative treatmentn = 79reference
- Primary endpoint
- Composite of:
- All-cause death
- Acute MI
- Stroke
- Unplanned heart failure (HF) hospitalization
- Follow-up
- Median 63 months
Primary result
As reported in the abstract
Hazard ratio
0.42
95% CI 0.24–0.73
P = 0.002
Events by treatment group
Early AVR vs Conservative treatment
HR 0.42 (95% CI 0.24–0.73); P = 0.002
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause death | 0.44 (0.23–0.85) | P = 0.012 | |
| HF hospitalization | 0.21 (0.06–0.73) | P = 0.007 | |
| 0.050.21520Hazard ratio (log scale) |
Original publication
Aortic valve replacement vs. conservative treatment in asymptomatic severe aortic stenosis: long-term follow-up of the AVATAR trial. Eur Heart J. Published 1 September 2024. doi:10.1093/eurheartj/ehae585
Summarised from the published abstract; every number is checked against it