Ney Carter Borges/LinkedIn
Apr 2, 2026, 16:08
Ney Carter Borges: Early Surgery vs Conservative Care in Asymptomatic Very Severe Aortic Stenosis
Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared a post on LinkedIn:
”Early surgery vs conservative care in asymptomatic very severe aortic stenosis (10-year outcomes)
Key findings (Recovery Trial – 10-Year Follow-up)
Population:
Asymptomatic patients with very severe aortic stenosis
(AVA ≤0.75 cm², Vmax ≥4.5 m/s)
Primary Outcome (CV death or operative mortality):
- Early Surgery: 3%
- Conservative Care: 24%
- HR 0.10 (95% CI 0.02–0.43; p=0.002)
All-Cause Mortality:
- Early Surgery: 15%
- Conservative Care: 32%
- HR 0.42 (95% CI 0.21–0.86)
Heart Failure Hospitalization:
- Early Surgery: 0%
- Conservative Care: 19%
Number Needed to Treat (10 years):
- NNT ≈ 6 (CV death)
- NNT ≈ 7 (all-cause death)
Clinical interpretation
- Early intervention dramatically reduces cardiovascular mortality
- Benefit is sustained over 10 years (no curve convergence)
- Conservative strategy leads to:
- Delayed surgery
- Higher HF burden
- Increased pre-operative risk
- Key insight: ‘Waiting for symptoms may allow irreversible myocardial damage’
Practice-changing message
In carefully selected asymptomatic patients with very severe AS, early surgical AVR should be strongly considered, especially when:
- Low surgical risk
- High transvalvular velocity
- Evidence of disease progression”
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