Many cardiologists are convinced that early surgery in asymptomatic aortic stenosis (AS) saves lives. However there is currently no direct evidence for this and most recommendations from the ESC/ EACTS or ACC/ AHA in this field are supported by Level-B or C evidence. Therefore, the investigators designed a randomized controlled trial to demonstrate whether early surgery improves mortality and morbidity of patients with asymptomatic severe AS and low operative risk.

Inclusion criteria

• Adult patient, aged between 18 and 80 years (18 ≤ age ≤80)
• Low operative risk, defined as EuroSCORE II ≤ 5%
• No symptom potentially attributable to AS: no dyspnea, angina or syncope during exercise
• No class I indication for surgery
• No symptom/ fall in blood pressure during exercise test
• Severe AS according to current echocardiography criteria: Vmax > 4.0 m/s and/ or MPG > 40 mm Hg); AVA < 1.0 cm2 (not mandatory)
• Preserved LV systolic function: LVEF >50% according to echocardiography ; no LV wall motion abnormality
• Signed informed consent

Exclusion criteria

• Moderate/ high operative risk for aortic valve replacement, defined as EuroSCORE II > 5%
• Class-I indication for AVR (ESC-EACTS 2012, ACC/ AHA 2014) or fall in blood pressure during exercise testing (Class-IIa)
• Other indication for cardiac surgery (CABG, thoracic aorta)
• Positive exercise test including A/ unmasking of symptoms (angina, dyspnea at low workload, dizziness or syncope) during exercise or B/ Fall in systolic blood pressure during exercise below the baseline value.
• Patients unable to perform the exercise ECG
• More than mild AR (>grade 2/4)/ other significant valve disease LVEF ≤ 50%
• Serum creatinine >160 μmol/L
• Serious extra cardiac comorbidity/ life expectancy <2 years
• Patient included in another trial with signed informed consent
• Patient not affiliated to social insurance
• Pregnancy