Journal Article

Rationale and design of the early valve replacement in severe asymptomatic aortic stenosis trial

Brookes, Cassandra L., Myles, Paul S., Paola, Ana Suazo Di, Richardson, Carla, Gilbert, Tom, Dweck, Marc R., Aslam, Saadia, Newby, David E., Briffa, Tom, McCann, Gerry P., Chow, Clara K., Lord, Joanne, Stewart, Ralph A. H, Barber, Shaun, Singh, Anvesha, Murphy, Gavin J., Akowuah, Enoch F., Hillis, Graham S., Selvanayagam, Joseph

2024

Overview

Aortic valve replacement in asymptomatic severe aortic stenosis is controversial. The Early valve replacement in severe ASYmptomatic Aortic Stenosis (EASY-AS) trial aims to determine whether early aortic valve replacement improves clinical outcomes, quality of life and cost-effectiveness compared to a guideline recommended strategy of ‘watchful waiting’. In a pragmatic international, open parallel group randomized controlled trial (NCT04204915), 2844 patients with severe aortic stenosis will be randomized 1:1 to either a strategy of early (surgical or transcatheter) aortic valve replacement or aortic valve replacement only if symptoms or impaired left ventricular function develop, or other cardiac surgery becomes nessessary. Exclusion criteria include other severe valvular disease, planned cardiac surgery, ejection fraction <50%, previous aortic valve replacement or life expectancy <2 years. The primary outcome is a composite of cardiovascular mortality or heart failure hospitalization. The primary analysis will be undertaken when 663 primary events have accrued, providing 90% power to detect a reduction in the primary endpoint from 27.7% to 21.6% (hazard ratio 0.75). Secondary endpoints include disability-free survival, days alive and out of hospital, major adverse cardiovascular events and quality of life. Recruitment commenced in March 2020 and is open in the UK, Australia, New Zealand, and Serbia. Feasibility requirements were met in July 2022, and the main phase opened in October 2022, with additional international centers in set-up. The EASY-AS trial will establish whether a strategy of early aortic valve replacement in asymptomatic patients with severe aortic stenosis reduces cardiovascular mortality or heart failure hospitalization and improves other important outcomes. [Display omitted]

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aorta / Aortic stenosis / Aortic valve / Aortic Valve - surgery / Aortic Valve Stenosis - surgery / Asymptomatic / Asymptomatic Diseases / Cardiology / Cardiovascular disease / Cardiovascular diseases / Clinical outcomes / Congestive heart failure / Consent / Coronary artery disease / Cost effectiveness / Cost-Benefit Analysis / Ejection fraction / Female / Heart diseases / Heart failure / Heart surgery / Heart Valve Prosthesis Implantation - methods / Heart valves / Humans / Life expectancy / Life span / Male / Medical prognosis / Mortality / Multicenter Studies as Topic / Patients / Pragmatic Clinical Trials as Topic / Pulmonary arteries / Quality of Life / Questionnaires / Randomized Controlled Trials as Topic / Rheumatic heart disease / Severity of Illness Index / Surgery / Transcatheter Aortic Valve Replacement - methods