Key result
Aortic valve replacement significantly reduced the risk of hospitalization for heart failure (RR 0.11; 95% CI 0.02-0.56; P=0.008) compared with conservative management in asymptomatic severe AS.
Why the study?
Although aortic valve replacement is recommended for symptomatic severe aortic stenosis, evidence for its role in asymptomatic patients with severe aortic stenosis remains controversial.
Does aortic valve replacement reduce adverse clinical outcomes in asymptomatic patients with severe aortic stenosis compared to conservative management?
Meta-Analysis (n=1,203)
Does aortic valve replacement reduce adverse clinical outcomes in asymptomatic patients with severe aortic stenosis compared to conservative management?
Relative Risk: 0.11 (95% CI 0.02–0.56)
p-value: p=0.008
In asymptomatic patients with severe aortic stenosis, aortic valve replacement significantly reduces the risk of heart failure hospitalization compared to conservative management, though it does not significantly reduce all-cause mortality.
Early AVR reduces HF hospitalization risk in asymptomatic severe AS without mortality difference; extends RCT evidence favoring intervention over surveillance.
Aortic valve replacement (AVR) is recommended for symptomatic severe aortic stenosis (AS) patients. However, evidence of its role in asymptomatic patients with severe AS remains controversial. Hence, a systematic review and meta-analysis of randomized controlled trials comparing AVR to conservative management in patients with asymptomatic severe AS was conducted. A systematic literature search was performed on electronic databases including MEDLINE (via PubMed), Embase, and Cochrane CENTRAL Library until November 2024. A random effects model was used to pool individual risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) using Review Manager Version 5.4.1 to calculate pooled effect estimates. Three randomized controlled trials with 1203 patients (42% females) were included. On pooled analysis, AVR significantly reduced the risk of hospitalization for heart failure (RR = 0.11, CI: 0.02-0.56, P = 0.008) compared with conservative care. However, there were no significant differences between the 2 groups in all-cause mortality (RR = 0.63, CI: 0.36-1.11, P = 0.11), stroke (RR = 0.59, CI: 0.35-1.01, P = 0.05), myocardial infarction (RR = 0.43, CI: 0.06-2.92, P = 0.38), or thromboembolic events (RR = 0.54, CI: 0.13-2.29, P = 0.40). In asymptomatic patients with severe AS, AVR significantly reduces the risk of hospitalization due to heart failure, with comparable risks in terms of all-cause mortality, myocardial infarction, stroke, and thromboembolic events compared with conservative management.
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Shahid et al. (2025) conducted a meta-analysis in Asymptomatic severe aortic stenosis (n=1,203). Aortic valve replacement vs. Conservative management was evaluated on Hospitalization for heart failure (RR 0.11, 95% CI 0.02-0.56, p=0.008). Aortic valve replacement significantly reduced the risk of hospitalization for heart failure (RR 0.11; 95% CI 0.02-0.56; P=0.008) compared with conservative management in asymptomatic severe AS.
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