Asymptomatic aortic stenosis: When is the right time for treatment?

In 2025, the FDA approved the early use of transcatheter aortic valve implantation (TAVI) in patients with severe but asymptomatic aortic stenosis. This decision challenges the previous practice of only intervening when symptoms appeared—an approach that made sense for a long time, as open-heart surgery meant a long recovery time.

TAVI now enables a less invasive procedure, with recovery measured in days rather than weeks.

However, the EVOLVED study, published in October 2025, examined the benefits of early intervention versus controlled waiting in patients with severe aortic stenosis and evidence of myocardial scarring. The study showed no clear advantage for early treatment.

Therefore, the best course of action remains unclear, and careful, individual consideration prior to intervention is currently recommended—especially for asymptomatic patients.