Abstract 14070: Role of Early Aortic Valve Replacement versus Conventional Management in Asymptomatic Patients With Severe Aortic Stenosis: A Meta-Analysis

Abstract

Introduction: Aortic-valve replacement (AVR) is an effective therapy for patients with severe symptomatic aortic stenosis (AS) but the appropriate timing of intervention for asymptomatic patients with severe AS remains controversial. Increased mortality associated with the onset of symptoms challenges the conventional “watchful waiting” strategy followed for this subset of patients. An early intervention may be warranted, however the data supporting this hypothesis is small. Our aim was to perform meta-analysis looking at outcomes of early surgical AVR (SAVR) in asymptomatic severe AS patients with preserved LVEF. Methods: Electronic databases were searched for studies comparing early SAVR and conventional treatment in patients with asymptomatic severe AS and normal LV function. The primary outcome of interest was all cause mortality. Secondary outcome was heart failure hospitalization. Random-effects model was used to estimate the pooled risk ratio (RR), and 95% confidence interval (CI) using Revman 5.4.1. Subgroup analysis stratified by study design was performed. Heterogeneity was assessed by Higgins I 2 statistic. Results: We found total of 8 studies (2 RCTs; 6 observational) from which 2669 patients with asymptomatic severe AS were identified. 1354 underwent SAVR and 1315 were managed conservatively. The mean age was 68 years with mean follow up duration of 4.8±2 years. There was statistically significant reduction in all-cause mortality (RR: 0.37; CI: 0.27-0.50; p<0.05; I2 = 68%) and heart failure hospitalization (RR: 0.24; CI: 0.16-0.36; p<0.05; I2 = 0%) among patients who underwent AVR compared with conservative treatment with subgroup analysis by study design showing similar trends. Conclusion: Our meta-analysis shows that compared with conventional treatment strategy, early SAVR in asymptomatic patients with severe AS is associated with improved long-term outcomes notably reduced all cause mortality and heart failure hospitalizations.