Abstract
Background
Conservative care has been the conventional treatment paradigm in asymptomatic severe aortic stenosis (AS) with preserved left ventricular systolic function (LVSF). However, this watchful waiting strategy was recently debated with the results of recent randomized controlled trials showing advantages of early aortic valve replacement (AVR) in asymptomatic severe AS with preserved LVSF. Hence, a meta-analysis is imperative.
Methods
PubMed, Cochrane and Embase databases were systematically searched for studies from inception until 31 December 2022. The search key terms were ‘asymptomatic’, ‘severe aortic stenosis’, and ‘aortic valve replacement’. Two independent reviewers appraised the eligible studies using a well-defined criteria. The main outcomes of interest were all-cause mortality, cardiovascular mortality, and hospitalization for heart failure. Random-effects model was used to derive pooled estimates.
Results
The search yielded 6 studies comprised of 2 randomized controlled trials and 4 observational studies. The total number of patients included was 1,744 (early AVR= 765; watchful waiting= 979). Our pooled estimates showed that early AVR as compared to a watchful waiting strategy in asymptomatic severe AS with preserved LVSF was associated with lower all-cause mortality (OR -0.11, 95% CI -0.19- 0.04, p <0.005, I2= 0%), cardiovascular mortality (OR 0.05, 95% CI 0.01- 0.26, p <0.004, I2= 0%), and hospitalization for heart failure (OR 0.13, 95% CI 0.04- 0.42, p <0.0006, I2= 0%).
Conclusion
Early AVR was associated with better outcomes compared to a watchful waiting strategy in asymptomatic severe aortic stenosis with preserved left ventricular systolic function.