2022
DOI: 10.1136/heartjnl-2022-321411
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Early surgical intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis

Abstract: ObjectiveTiming of intervention for patients with asymptomatic severe aortic stenosis (AS) remains controversial. To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in patients with asymptomatic severe AS.MethodsWe systematically searched PubMed, Embase and Cochrane databases, in December 2021, for studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.ResultsTwelve studies were included in which two w… Show more

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Cited by 7 publications
(3 citation statements)
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“…improve the clinical outcomes of asymptomatic severe AS patients compared with conservative management. [4][5][6][7][8][9][10] Potential factors which may favour an early intervention include reveal of symptoms during exercise testing, elevation of serum B-type natriuretic peptide level, cardiac imaging markers of early ventricular decompensation based on echocardiography, cardiac computed tomography (CT) and cardiac magnetic resonance. [11][12][13][14][15][16][17][18][19] Nevertheless, additional prospective data are needed to further demonstrate the benefit of early TAVR in asymptomatic patients, especially in those who may be considered as having higher lifetime risks.…”
Section: Strengths and Limitations Of This Studymentioning
confidence: 99%
See 1 more Smart Citation
“…improve the clinical outcomes of asymptomatic severe AS patients compared with conservative management. [4][5][6][7][8][9][10] Potential factors which may favour an early intervention include reveal of symptoms during exercise testing, elevation of serum B-type natriuretic peptide level, cardiac imaging markers of early ventricular decompensation based on echocardiography, cardiac computed tomography (CT) and cardiac magnetic resonance. [11][12][13][14][15][16][17][18][19] Nevertheless, additional prospective data are needed to further demonstrate the benefit of early TAVR in asymptomatic patients, especially in those who may be considered as having higher lifetime risks.…”
Section: Strengths and Limitations Of This Studymentioning
confidence: 99%
“…It is not unreasonable to consider early TAVR indications for asymptomatic patients, especially by identifying patients who are at higher risk of death. Currently, several observational studies and a randomised trial have revealed that early or selective AVR may improve the clinical outcomes of asymptomatic severe AS patients compared with conservative management 4–10. Potential factors which may favour an early intervention include reveal of symptoms during exercise testing, elevation of serum B-type natriuretic peptide level, cardiac imaging markers of early ventricular decompensation based on echocardiography, cardiac computed tomography (CT) and cardiac magnetic resonance 11–19.…”
Section: Introductionmentioning
confidence: 99%
“…This might result in great support of the cardiologists involved and might enable a deeper understanding of patients’ reported complaints, and helping in optimising follow-up and patient management. On the other hand, the difficulties in planning the follow-up of a large number of patients with AS might also be an incentive to consider wider indications of intervention in asymptomatic patients with severe AS, which is supported by a growing burden of evidence from observational series and, more importantly, two recent randomised controlled trials supporting early surgical treatment approach versus conservative management 8…”
mentioning
confidence: 99%