Added value of heart valve clinics in the management of asymptomatic aortic stenosis

Correspondence to Professor Bernard Iung, Cardiology, Bichat - Claude-Bernard Hospital Cardiology Service, 75018 Paris, Île-de-France, France; bernard.iung@aphp.fr The need for specific organisations of healthcare structures dedicated to the management of patients with valvular heart disease (VHD) emerged in guidelines on VHD in the 2010s with the introduction of the multidisciplinary heart team in the 2012 European Society of Cardiology (ESC)/European Association of CardioThoracic Surgery guidelines and of the heart valve team and heart valve centres in the 2014 American Heart Association/American College of Cardiology guidelines. [...]the risk of waiting for symptom onset is that the patient is referred for intervention late. Asymptomatic patients with severe AS account for 19% of patients referred to the hospital in the VHD II survey, and the percentage is likely to be higher in general practice. [...]the generalisation of the follow-up of asymptomatic patients with AS in heart valve clinics raises concerns on the feasibility and economic consequences of this approach. [...]the difficulties in planning the follow-up of a large number of patients with AS might also be an incentive to consider wider indications of intervention in asymptomatic patients with severe AS, which is supported by a growing burden of evidence from observational series and, more importantly, two recent randomised controlled trials supporting early surgical treatment approach versus conservative management.8 In anticipation of the results of ongoing randomised trials in the setting of asymptomatic AS, and regardless of all obstacles associated with the implementation of heart valve clinics, the study by Paolisso et al is a good indicator about clinical and outcome benefits associated with this approach.