Key result
Early AVR reduces stroke risk ~38% vs conservative management in asymptomatic severe AS, without impacting mortality.
Why the study?
The clinical benefits of early aortic valve replacement versus conservative management in asymptomatic severe aortic stenosis remained unclear.
Does early aortic valve replacement reduce adverse clinical outcomes in asymptomatic patients with severe aortic stenosis?
Meta-Analysis (n=1,427)
Does early aortic valve replacement reduce adverse clinical outcomes in asymptomatic patients with severe aortic stenosis?
Effect estimate: RR 0.62 (95% CI 0.40-0.95)
p-value: p=0.03
In asymptomatic severe aortic stenosis, early aortic valve replacement reduces stroke risk but does not significantly impact mortality compared to conservative management.
Reduces stroke risk with early AVR in asymptomatic severe AS without mortality impact; reinforces consensus for timely intervention in this population.
Background Aortic stenosis (AS) is a progressive disease with high morbidity. Early aortic valve replacement (AVR), including transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), may prevent complications and improve outcomes. However, the benefits of early intervention versus conservative management in asymptomatic severe AS remain unclear. Purpose This systematic review and meta-analysis aimed to compare early AVR (TAVR/SAVR) with conservative management in asymptomatic patients with severe AS. Methods We conducted a comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing AVR with standard conservative therapy in asymptomatic patients with severe AS. Statistical analysis was carried out utilizing Review Manager version 5.4. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²>25% were considered significant heterogeneity. The outcomes assessed included stroke incidence, all-cause mortality, cardiovascular death, new-onset atrial fibrillation (AF), and major bleeding. Results Four RCTs were included, comprising 1,427 participants, 927 of whom underwent TAVR. The incidence of stroke was significantly lower in the AVR group compared to the conservative group (RR 0.62; 95% CI: 0.40-0.95; p = 0.03; Figure 1). However, there was no significant reduction in all-cause mortality (HR 0.68; 95% CI: 0.40-1.17; p = 0.17), cardiovascular mortality (RR 0.97; 95% CI: 0.55-1.72; p = 0.92), or myocardial infarction (RR 0.23; 95% CI: 0.05-1.06; p = 0.06). The incidence of new-onset AF (RR 1.10; 95% CI: 0.80-1.52; p = 0.56) and major bleeding (RR 0.80; 95% CI: 0.43-1.52; p = 0.50) were similar between the groups. Conclusion Our systematic review and meta-analysis suggest that early aortic valve replacement reduces stroke risk in asymptomatic severe aortic stenosis but has no significant impact on mortality or other major outcomes.
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Lucena et al. (2025) conducted a meta-analysis in Asymptomatic severe aortic stenosis (n=1,427). Early aortic valve replacement (TAVR/SAVR) vs. Conservative management was evaluated on Stroke incidence (RR 0.62, 95% CI 0.40-0.95, p=0.03). Early aortic valve replacement reduced stroke risk versus conservative management in asymptomatic severe aortic stenosis (RR 0.62; 95% CI 0.40-0.95; p=0.03), with no significant impact on mortality.
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