Background 

The management of patients with severe but asymptomatic aortic stenosis is challenging. Evidence on early aortic valve replacement (AVR) versus symptom-driven intervention in these patients is unknown.

Methods 

Electronic databases were searched, articles comparing early-AVR with conservative management for severe aortic stenosis were identified. Pooled adjusted odds ratio (OR) was computed using a random-effect model to determine all-cause and cardiovascular mortality.

Results 

A total of eight studies consisting of 2201 patients were identified. Early-AVR was associated with lower all-cause mortality [OR 0.24, 95% confidence interval (CI) 0.13–0.45, P ≤ 0.00001] and cardiovascular mortality (OR 0.21, 95% CI 0.06–0.70, P = 0.01) compared with conservative management. The number needed to treat to prevent 1 all-cause and cardiovascular mortality was 4 and 9, respectively. The odds of all-cause mortality in a selected patient population undergoing surgical AVR (SAVR) (OR 0.16, 95% CI 0.09–0.29, P ≤ 0.00001) and SAVR or transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35–0.81, P = 0.003) were significantly lower compared with patients who are managed conservatively. A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24, 95% CI 0.11–0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20, 95% CI 0.08–0.51, P = 0.0008) also mirrored the findings of overall results.

Conclusion 

Patients with asymptomatic aortic valve stenosis have lower odds of all-cause and cardiovascular mortality when managed with early-AVR compared with conservative management. However, because of significant heterogeneity in the classification of asymptomatic patients, large scale studies are required.

中文翻译：

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早期干预或观察等待无症状的严重主动脉瓣狭窄：系统评价和荟萃分析

背景 

患有严重但无症状的主动脉瓣狭窄的患者的治疗具有挑战性。这些患者早期主动脉瓣置换术（AVR）与症状驱动干预的证据尚不清楚。

方法 

检索了电子数据库，发现了比较早期AVR与保守治疗严重主动脉瓣狭窄的文章。使用随机效应模型计算合并调整后的优势比（OR），以确定所有原因和心血管疾病的死亡率。

结果 

共鉴定出八项研究，共2201名患者。早-AVR是与较低的全因死亡率[OR 0.24，95％置信区间（CI）0.13-0.45，相关联的P ≤0.00001]和心血管疾病的死亡率（OR 0.21，95％CI 0.06-0.70，P相比= 0.01）保守管理。预防1种全因死亡和心血管疾病死亡所需的治疗分别为4和9。全因死亡率的在所选择的患者群体进行外科AVR（SAVR）（OR 0.16，95％CI 0.09-0.29，胜算P ≤0.00001）和SAVR或经导管AVR（TAVR）（OR 0.53，95％CI 0.35- 0.81，P= 0.003）与保守治疗的患者相比明显降低。基于严重主动脉瓣狭窄（OR 0.24，95％CI 0.11–0.52，P = 0.0004）与非常严重的主动脉瓣狭窄（OR 0.20，95 ％CI 0.08–0.51，P = 0.0008）的亚组敏感性分析也反映了总体结果结果。

结论 

与保守治疗相比，无症状主动脉瓣狭窄的患者采用早期AVR进行治疗时，全因和心血管疾病死亡的几率较低。但是，由于无症状患者的分类存在很大的异质性，因此需要进行大规模研究。