Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis
Philippe Généreux, Marko Banović, Duk‐Hyun Kang, Gennaro Giustino, Bernard Prendergast, Brian R. Lindman, David E. Newby, Philippe Pîbarot, Björn Redfors, Neil Craig, Jozef Bartúnek, Allan Schwartz, Roxanna Seyedin, David J. Cohen, Bernard Iung, Martin B. Leon, Marc R. Dweck
Abstract
BACKGROUND: Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction. OBJECTIVES: The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS. METHODS: Studies were quantitatively assessed in a meta-analysis using random-effects modeling. Prespecified outcomes included all-cause and cardiovascular mortality, unplanned cardiovascular or heart failure (HF) hospitalization, and stroke. The meta-analysis is registered at the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202490002). RESULTS: = 50%; P = 0.23) were observed with early AVR compared with CS, although there was a high degree of heterogeneity among studies. CONCLUSIONS: In this meta-analysis of 4 RCTs, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.