Earlier timing of aortic valve surgery for severe aortic regurgitation and/or stenosis was associated with a long-term survival benefit compared to current guideline recommendations.
Systematic Review
Does earlier timing of aortic valve surgery improve long-term survival in patients with chronic aortic regurgitation and/or aortic stenosis compared to current guidelines?
Early aortic valve replacement for severe aortic valve disease appears to offer a long-term survival benefit compared to current guideline-directed timing.
Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to the guidelines' release, several studies have been published that suggest a survival benefit from earlier timing of surgery for severe AR and/or AS. The aim of this review was to determine whether patients who have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a survival benefit from earlier timing of aortic valve surgery. Medical databases were systematically searched from January 2015 to April 2020 for randomized controlled trials (RCTs) and observational studies that examined the timing of aortic valve replacement surgery for chronic AR and/or AS. For chronic AR, four observational studies and no RCTs were identified. For chronic AS, five observational studies, one RCT and one meta-analysis were identified. One observational study examining mixed aortic valve disease (MAVD) was identified. All of these studies, for AR, AS, and MAVD, found long-term survival benefit from timing of aortic valve surgery earlier than the current guidelines. Larger prospective RCTs are required to evaluate the benefit of earlier surgical intervention.
Koerber et al. (Thu,) conducted a systematic review in Chronic aortic regurgitation (AR) and/or aortic stenosis (AS). Earlier timing of aortic valve surgery vs. Current guideline recommendations for timing was evaluated on Long-term survival. Earlier timing of aortic valve surgery for severe aortic regurgitation and/or stenosis was associated with a long-term survival benefit compared to current guideline recommendations.