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Don't wait for things to get worse. The PROGRESS trial — the first randomized study of its kind — found that upfront TAVR significantly reduced death and heart failure events in patients with moderate aortic stenosis and at least one at-risk feature, compared to clinical surveillance. The results, published in the NEJM, are already being called "practice-changing."
Don't wait for things to get worse. The PROGRESS trial — the first randomized study to compare upfront transcatheter aortic valve replacement (TAVR) against clinical surveillance in moderate aortic stenosis (AS) — delivered a clear verdict: intervene earlier. Among 744 patients aged 65+ with moderate AS and at least one at-risk feature, those who received upfront TAVR had significantly fewer deaths or heart failure events at 2 years compared to those under surveillance.
The trial also revealed just how quickly moderate AS can progress — over 57% of surveillance patients eventually needed a valve replacement by 24 months, and more than 80% of those had already advanced to severe AS. Lead investigator Dr. Philippe Généreux argued for scrapping the moderate vs. severe AS distinction altogether, pushing instead for intervention based on "clinically significant" AS.
By the Numbers:
Why it matters: Moderate AS has long been considered a "wait and see" condition, but PROGRESS flips that script. With patients progressing faster than expected and quality of life improving dramatically post-TAVR, the trial makes a compelling case for earlier intervention — and could significantly expand the pool of TAVR candidates.
