Timing of surgery in asymptomatic aortic stenosis.

Prospective studies have convincingly shown that sudden death in asymptomatic patients with AS is rare and prognosis is good as long as LV function, exercise tolerance and exercise hemodynamics remain normal. The time interval to development of LV dysfunction is not known. Therefore the initial evaluation should be confirmed after 3-6 months including echocardiography and exercise testing to identify patients with rapid progression, LV dysfunction and other high risk patients in whom surgery can be expected to improve prognosis even if the patient remains asymptomatic.