Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients with Severe Aortic Stenosis: A Systematic Review and Meta-Analysis.
The merits of conservative management versus early intervention in patients with asymptomatic severe aortic stenosis remain unknown. Digital databases (MEDLINE, Google Scholar, and Embase) were searched for all relevant studies from inception through September 2022. Studies comparing conservative management with early intervention were compared using a random-effects model to calculate risk ratios (RRs) with 95% confidence interval (CI). A total of 11 studies comprising 5,030 patients (1,874 patients were in the early intervention i.e., surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) group, and 3,156 in the conservative group) were included in the analysis. The average follow-up time was 4.49 years. Early intervention was associated with a significantly reduced risk of heart failure hospitalization (RR 0.27, 95% CI 0.11- 0.67; P = 0.004), cardiac (RR 0.38, 95% CI 0.26 - 0.56; P < 0.00001), non-cardiac (RR 0.40, 95% CI 0.31-0.50; P < 0.00001), and all-cause mortality (RR 0.35, 95% CI 0.27 - 0.44; P < 0.00001) compared with conservative management. There was no significant difference in the 30-day mortality (RR 1.30, 95% CI 0.22 - 7.66; P = 0.77), 90-day mortality (RR 0.49, 95% CI 0.12 - 2.02; P = 0.32) or myocardial infarction (RR 0.57, 95% CI 0.32 - 1.02; P = 0.06) between the two groups. This meta-analysis shows statistically significant reductions in the risk for all-cause mortality, cardiac specific mortality, non-cardiac mortality, sudden cardiac death, and heart failure hospitalizations in patients with asymptomatic aortic stenosis who underwent early intervention as opposed to conservative management.
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Yasmin, F., Shaikh, A., Asghar, M. S., Najeeb, H., Moeed, A., Waqar, E., Ram, M. D., Nankani, A., Ochani, R. K., Jawed, R., Aamir, M., Ullah, W., Waqar, F., & Johnson, D. M. (2022). Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients with Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Current problems in cardiology, 101477. Advance online publication. https://doi.org/10.1016/j.cpcardiol.2022.101477
Medicine and Health Sciences
Cardiology Division, Department of Medicine Fellows and Residents, Fellows and Residents