{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:19:57Z","timestamp":1790363997060,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The management of asymptomatic severe aortic stenosis (AS) has traditionally relied on watchful waiting until the onset of symptoms or left ventricular dysfunction. However, the FDA's approval of transcatheter aortic valve replacement (TAVR) with the Sapien 3 platform in May 2025, based on the EARLY TAVR trial, has intensified the debate over early intervention. This Viewpoint synthesizes evidence from randomized trials (RECOVERY, AVATAR, EVOLVED, EARLY TAVR) and registries (HAVEC, VALVENOR) to evaluate the role of early aortic valve replacement (AVR). Early intervention is associated with reductions in combined endpoints of cardiovascular hospitalizations, stroke, and mortality in selected patients, with the EARLY TAVR demonstrating a 50% reduction in major cardiovascular events. Nonetheless, evidence remains inconsistent, particularly in low-risk populations, as the EVOLVED trial showed no mortality benefit in patients with myocardial fibrosis, warranting cautious interpretation. A conservative surveillance strategy remains appropriate in some cases, supported by the low annual risk of sudden death (i.e., 0.65% per year) and ongoing concerns over valve durability and procedural risks. Given the heterogeneity of patient and valve phenotypes, a personalized risk assessment, combining clinical evaluation, biomarkers (troponin, BNP), and imaging (echocardiography, CMR), is proposed to identify high-risk patients and optimize the timing of early intervention. Expert heart team guidance is essential, and routine early intervention cannot yet be recommended. Further research is needed to refine strategies and improve outcomes in this evolving clinical landscape.<\/jats:p>","DOI":"10.1093\/ehjopen\/oeaf114","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T03:55:58Z","timestamp":1756439758000},"source":"Crossref","is-referenced-by-count":5,"title":["Early Aortic Valve Intervention in Asymptomatic Severe Aortic Stenosis: A Clinical Dilemma in Evolution"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-8194","authenticated-orcid":false,"given":"Patrizio","family":"Lancellotti","sequence":"first","affiliation":[{"name":"GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Li\u00e8ge Hospital , Li\u00e8ge ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospital CHU Sart Tilman , Li\u00e8ge B-4000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1662-7874","authenticated-orcid":false,"given":"Augustin","family":"Coisne","sequence":"additional","affiliation":[{"name":"Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille , U1011- EGID, F-59000 Lille ,","place":["France"]},{"name":"Cardiovascular Research Foundation , New York City, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Cosyns","sequence":"additional","affiliation":[{"name":"Centrum Voor Harten Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel) , Brussels ,","place":["Belgium"]},{"name":"In vivo Cellular and Molecular Imaging (ICMI) Center, Vrije Universiteit Brussel (VUB) , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Dulgheru","sequence":"additional","affiliation":[{"name":"GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Li\u00e8ge Hospital , Li\u00e8ge ,","place":["Belgium"]},{"name":"Department of Cardiology, University Hospital CHU Sart Tilman , Li\u00e8ge B-4000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Garbi","sequence":"additional","affiliation":[{"name":"Royal Papworth Hospital, Cambridge University Health Partners, Cambridge Biomedical Campus , Cambridge ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-3304","authenticated-orcid":false,"given":"Geu-Ru","family":"Hong","sequence":"additional","affiliation":[{"name":"Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jadranka Separovic","family":"Hanzevacki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8373-8486","authenticated-orcid":false,"given":"Marco","family":"Moscarelli","sequence":"additional","affiliation":[{"name":"Imperial College London, Department of Surgery & Cancer - Faculty of Medicine , London ,","place":["United Kingdom"]},{"name":"Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research , Palermo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadafumi","family":"Sugimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nagoya City University Mirai Kousei Hospital , Nagoya ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-3389","authenticated-orcid":false,"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Rennes, CHU Rennes, Service de Cardiologie Inserm , LTSI-UMR 1099, Rennes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-9519","authenticated-orcid":false,"given":"Khalil","family":"Fattouch","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Maria Eleonora Hospital, GVM Care&Research , Palermo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Habib","sequence":"additional","affiliation":[{"name":"Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France; 2 Aix Marseille University, IRD, APHM, MEPHI, IHU-M\u00e9diterrane\u00e9e Infection , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Vannan","sequence":"additional","affiliation":[{"name":"Marcus Heart Valve Center, Piedmont Heart Institute , Atlanta ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-279X","authenticated-orcid":false,"given":"Philippe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Quebec Heart and Lung Institute, Universit\u00e9 Laval , Qu\u00e9bec City, Quebec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,29]]},"container-title":["European Heart Journal Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeaf114\/64157778\/oeaf114.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeaf114\/64157778\/oeaf114.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T03:55:58Z","timestamp":1756439758000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article\/doi\/10.1093\/ehjopen\/oeaf114\/8243644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/ehjopen\/oeaf114","relation":{},"ISSN":["2752-4191"],"issn-type":[{"value":"2752-4191","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"article-number":"oeaf114"}}