The management of aortic stenosis (AS) continues to expand toward earlier and less invasive intervention. Two recent trials define the frontier. The EARLY TAVR trial showed that in asymptomatic severe AS, early transcatheter aortic valve replacement (TAVR) significantly reduced the composite of death, stroke, or unplanned cardiovascular hospitalization compared with watchful waiting (26.8% vs 45.3%) — challenging the traditional practice of waiting for symptoms. The DEDICATE trial found TAVR non-inferior to surgical aortic valve replacement for death or stroke at one year in low- to intermediate-risk patients, reinforcing TAVR as a valid alternative to surgery across the risk spectrum.
There is still no approved medical therapy that slows the progression of calcific AS, but this is an active research area: candidate targets highlighted by the American Heart Association include lipoprotein(a) (with agents such as pelacarsen), inflammation (colchicine), and endothelial pathways (evogliptin). Until such therapy is proven, management remains valve replacement, with timing the central question.
Further reading: EARLY TAVR (Généreux et al., NEJM 2025); DEDICATE (Blankenberg et al., NEJM 2024); AHA scientific statement on medical therapy targets in valvular heart disease (Small et al., Circulation 2024).