The 2025 ESC/EACTS guidelines support earlier aortic valve replacement in many asymptomatic severe aortic stenosis patients, improving outcomes via proactive management.
Does a proactive management strategy improve outcomes compared to symptom-driven watchful waiting in patients with severe aortic stenosis?
This international expert perspective provides an operational framework supporting the 2025 ESC/EACTS guidelines' shift toward earlier, proactive treatment of severe aortic stenosis.
The 2025 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines mark a pivotal change, challenging the paradigm of symptom-driven watchful waiting, and supporting earlier treatment in many patients with asymptomatic severe aortic stenosis. Building on this foundation, this international expert perspective advocates a comprehensive, proactive management strategy and offers clinicians a contemporary operational framework for managing severe aortic stenosis. Key evidence-based elements include early referral to the multidisciplinary Heart Valve Team, streamlined evaluation, upstream testing, prompt aortic valve replacement in many asymptomatic patients, more urgent treatment for symptomatic patients, and structured surveillance involving close working relationships between the referring clinician and Heart Valve Team when intervention is deferred. This proactive evidence-based model aims to improve timeliness, efficiency, and equity of care, thereby reducing preventable morbidity and mortality and improving long-term outcomes.
Cook et al. (2026) studied this question. The 2025 ESC/EACTS guidelines support earlier aortic valve replacement in many asymptomatic severe aortic stenosis patients, improving outcomes via proactive management.