Asymptomatic patients with very severe aortic stenosis-operate or watch?

The Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis (RECOVERY) trial has for the first time compared the strategy of surgery or observation in a randomized fashion. This was a prospective, randomized, multi-center trial that included 145 patients in total. Median follow-up was for just over 6 years. During follow-up, the rate of sudden death was 14% at 8 years in the conservative strategy group and 74% of the patients crossed over from the conservative treatment to the surgery arm. The main issues with the trial were inclusion of patients who may have already met the class IIa criteria for aortic valve replacement, as well as inability to accurately assess patients for presence of symptoms at the time of randomization. While the trial confirms that patients with very severe aortic stenosis do have a poor long-term outcome, because of the study design limitations, it does not confirm a definitive argument for early intervention. © Indian Association of Cardiovascular-Thoracic Surgeons 2021.