Cardionerds: A Cardiology Podcast 427. The Approach to Asymptomatic Severe Aortic Stenosis with Dr. Parth Desai and Dr. Tony Bavry
Sep 11, 2025
In this engaging discussion, Dr. Tony Bavry, a leading expert in interventional cardiology, and Dr. Parth Desai, a structural interventional cardiologist, dive deep into asymptomatic severe aortic stenosis. They explore the complexities of managing these patients and the significance of rigorous evaluation and risk stratification. Recent clinical trials, including Recovery and Avatar, shed light on early surgical interventions. The transformative impact of TAVR is also highlighted, showcasing how innovative techniques are revolutionizing treatment and improving patient outcomes.
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Case: Active 78-Year-Old With Severe AS
- Mr. Artie Stenow is a 78-year-old active man with severe high-gradient AS but no symptoms and LVEF 60%.
- He exercises regularly and was referred to the structural clinic after an incidental murmur and echo confirmed severe AS.
Latent Then Malignant Course
- Aortic stenosis has a long latent asymptomatic phase but becomes malignant once symptoms develop.
- Event-free survival drops sharply and one-year mortality approaches 50% after symptoms appear.
Follow Guideline Indications For AVR
- Offer AVR for asymptomatic severe AS with LVEF <50% or when patients are having other cardiac surgery.
- Consider AVR for very high velocity (>5 m/s), markedly elevated BNP, abnormal exercise test, or rapid progression.
