Timing of valve replacement for aortic stenosis.

V alve replacement for aortic stenosis is easily recognized as life saving, because of the short survival of most patients with advanced symptomatic stages of aortic stenosis. However, there is an increased late mortality from congestive heart failure occurring years after the aortic valve replacement. This problem has been thought to relate to irreversible myocardial changes, manifested morphologically as myocardial hypertrophy and interstitial fibrosis.1 Valve replacement earlier in the natural history of aortic stenosis has been advocated but has been restrained by the risk of complications of the artificial valve.