Early Aortic Valve Replacement vs. Conservative Management in Asymptomatic Severe Aortic Stenosis Patients With Preserved Ejection Fraction: A Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Asymptomatic severe aortic stenosis with preserved ejection fraction (n=1249). Intervention: Early aortic valve replacement vs. Conservative management. Primary outcome: All-cause mortality (OR 0.16, 95% CI 0.09-0.31, p=<0.00001).

Tan Yuan; Yi Lü; Chang Bian; Zhejun Cai

doi:10.3389/fcvm.2020.621149

February 3, 2021Frontiers in Cardiovascular MedicineOpen Access

Early Aortic Valve Replacement vs. Conservative Management in Asymptomatic Severe Aortic Stenosis Patients With Preserved Ejection Fraction: A Meta-Analysis

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Key result

Early aortic valve replacement significantly reduced all-cause mortality compared to conservative management in asymptomatic patients with severe aortic stenosis and preserved ejection fraction (OR 0.16).

Why the study?

The specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.

Study Design

Type

Meta-Analysis (n=1,249)

Multicenter

Yes

PICO

P

Population

1,249 asymptomatic patients with severe or very severe aortic stenosis and preserved ejection fraction (LVEF ≥50%) included in a meta-analysis of 4 studies.

I

Intervention / Comparator

Early aortic valve replacement vs Conservative management

O

Primary Outcome

All-cause mortality — OR 0.16 (0.09-0.31), p=<0.00001

Main Result

Odds Ratio: 0.16 (95% CI 0.09–0.31)

p-value: p=<0.00001

Limitations

The meta-analysis consists of only four studies, including three non-randomized trials that were subjected to possible selection bias.
Two articles were from the same research group.
Not every end-point was reported in the four included studies.
There was not enough data about operative mortality to compare it between groups.
Failed to include asymptomatic patients who underwent transcatheter aortic valve replacement (TAVR) due to limited data.
Failed to obtain original survival data.

Implication

May support early AVR over watchful waiting in selected patients; leaves open guideline change pending larger randomized confirmation.

Abstract

Background: Aortic stenosis (AS) is the most common valvular disease in developed countries. Until now, the specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial. Methods: A systematic search of four databases (Pubmed, Web of science, Cochrane library, Embase) was conducted. Studies of asymptomatic patients with severe AS or very severe AS and preserved left ventricular ejection fraction underwent early aortic valve replacement (AVR) or conservative care were included. The end points included all-cause mortality, cardiac mortality, and non-cardiac mortality. Results: Four eligible studies were identified with a total of 1,249 participants. Compared to conservative management, patients who underwent early AVR were associated with lower all-cause mortality, cardiac mortality, and non-cardiac mortality rate (OR 0.16, 95% CI 0.09–0.31, P < 0.00001; OR 0.12, 95% CI 0.02–0.62, P = 0.01; OR 0.36, 95% CI 0.21–0.63, P = 0.0003, respectively). Conclusions: Early AVR is preferable for asymptomatic severe AS patients with preserved ejection fraction.

Discussion

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Figures from the paper

Published by Frontiers in Cardiovascular Medicine · CC BY

Cite This Study

Yuan et al. (2021) conducted a meta-analysis in Asymptomatic severe aortic stenosis with preserved ejection fraction (n=1,249). Early aortic valve replacement vs. Conservative management was evaluated on All-cause mortality (OR 0.16, 95% CI 0.09-0.31, p=<0.00001). Early aortic valve replacement significantly reduced all-cause mortality compared to conservative management in asymptomatic patients with severe aortic stenosis and preserved ejection fraction (OR 0.16).

synapsesocial.com/papers/6a7f23bcb1a7ff7f700dfaf6 https://doi.org/10.3389/fcvm.2020.621149

View Full Paper

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Early Aortic Valve Replacement vs. Conservative Management in Asymptomatic Severe Aortic Stenosis Patients With Preserved Ejection Fraction: A Meta-Analysis

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Early Aortic Valve Replacement vs. Conservative Management in Asymptomatic Severe Aortic Stenosis Patients With Preserved Ejection Fraction: A Meta-Analysis

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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