[Asymptomatic severe aortic stenosis: always surgical treatment? The opinion of the cardiologist].

Aortic valve replacement is the effective treatment for symptomatic aortic stenosis. On the other hand, there is some lack of agreement about the optimal timing of surgery in asymptomatic patients. We support the opinion that survival of asymptomatic patients with aortic stenosis is excellent without surgery. At present even if surgical mortality can be minimized, the combined risk of surgery and late complications of a prosthesis exceed the possibility of preventing sudden death and prolonging survival in all asymptomatic patients. It may be useful to identify asymptomatic patients at high risk of sudden death, with abnormal response to exercise, or with left ventricular systolic dysfunction or excessive hypertrophy for early surgery. In the future, when surgical techniques and techniques for the preservation of biological valve are improved, or the risk of thromboembolism associated with mechanical prostheses is reduced, and the freshly harvested matched homografts become more widely available, the indications for aortic valve replacement will be extended to patients with hemodynamically severe aortic valve disease, in the absence of symptoms or left ventricular dysfunction.