PARIS – Aortic valve replacement (AVR) is best performed before symptom onset to improve outcomes in patients with aortic stenosis (AS) and reduce healthcare costs, a new study shows. Philippe Généreux, MD, from Morristown Medical Center, New Jersey, presented these findings during a Late-Breaking Trials session on Thursday at the EuroPCR Congress 2025. Clinical presentation prior to AVR comes in many forms. Patients may be symptomatic or with stable valve syndrome (SVS), mildly symptomatic or progressive valve syndrome (PVS) or acute valve syndrome (AVS). Patients with AVS had a mortality rate three times greater than patients with no symptoms and are four times more likely to have heart failure hospitalization (HFH) 2-years post-AVR. The investigators in this present study examined the relationship between patients’ clinical presentations before AVR and the clinical and economic outcomes before and after hospitalization for the procedure. Clinical outcomes evaluated included death, HFH, death or HFH and stroke or transient ischemic attack (TIA). Healthcare costs and utilization outcomes were measured via total cost (AVR +1-year healthcare costs), AVR length of stay, hospitalization for any reason and HF re-hospitalization. A database was used (Optum Market Clarity [Claims]) to identify adult patients who had AS and received AVR in the U.S. (total n=24,075). These patients were included in the studied and categorized into SVS (n=270, mean age=65.9 years, 31.1% female), PVS (n=10,195, mean age=70.1 years, 39.3% female) or AVS (n=13,610, mean age=72 years, 38.8% female) based on their clinical presentation 1-year before AVR. Patients with AVS had significantly higher rates of death (log-rank p<0.001), HFH (Gray’s test p<0.001), HFH or death (log-rank p<0.001) and stroke post-AVR (Gray’s test p<0.001). The AVR length of stay (p<0.001), hospitalizations during the 1-year follow-up period (p<0.001) and HF hospitalizations during the 1-year follow-up (p<0.001) were all highest in the AVS group, compared with SVS and PVS. The total cost of healthcare for AVS patients was $36,267 more than SVS patients, on average, and this cost for PVS patients was $27,410 more than SVS patients. Overall, the most frequently observed clinical presentation pre-AVR was AVS in this population, and AVS was associated with higher rates of death, HFH, death or HFH and stroke or TIA, as well as significantly greater healthcare costs. Image Credit: doidam10 – stock.adobe.com