Early Aortic Valve Replacement vs. Conservative Therapy in Asymptomatic Severe Aortic Stenosis Patients: A Meta-Analysis

Abstract

Background: Aortic stenosis (AS) is frequently seen in elderly individuals. However, the preferred strategy for asymptomatic severe AS remains unclear. We compared early aortic valve replacement (eAVR) with conservative care.

Methods: We conducted a systematic review and meta-analysis of RCTs from major databases until December 20, 2024. Risk ratios (RRs) and mean differences (MDs) were pooled with 95% confidence intervals (CIs) using R version 4.3.

Results: Four RCTs (1427 patients) showed no substantial difference in all-cause mortality between the early intervention and conservative care (RR: 0.69 [95% CI: 0.42–1.11]; p = 0.13). However, early intervention was markedly associated with a lower incidence of cardiovascular mortality (RR: 0.65 [95% CI: 0.44–0.96]; p = 0.03), hospitalization for heart failure (RR: 0.27 [95% CI: 0.13–0.54]; p < 0.01), and stroke (RR: 0.62 [95% CI: 0.40–0.95]; p = 0.03) compared to that of conservative care. Moreover, there was no significant difference between the two groups in myocardial infarction (RR: 0.22 [95% CI: 0.04–1.24]; p = 0.09), repeated aortic-valve surgery (RR: 0.74 [95% CI: 0.12–4.78]; p = 0.75), and thromboembolic complications (RR: 0.72 [95% CI: 0.23–2.21]; p = 0.56).

Conclusion: In asymptomatic severe AS, early AVR did not mitigate overall mortality but substantially lowered cardiovascular mortality, heart failure hospitalizations, and stroke risks compared to conservative management. Perioperative complications were similar in both groups.