Mazen Alayidh, Ahmed A. Ibrahim, Najla M. Alharthi, Ahmed Gaber Emara, Jawri Abdulhadi Alamri, Yara Fahad Almazyad, Tmadher G. Alshammari, Asma M. Alharbi, Esraa H. Mustafa, Raghad Zaki Alzaher, Mustafa Turkmani, Esameldin Shadoul
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Risk ratios (RRs) and mean differences (MDs) were pooled with 95% confidence intervals (CIs) using R version 4.3.</p><p><b>Results:</b> 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]; <i>p</i> = 0.13). However, early intervention was markedly associated with a lower incidence of cardiovascular mortality (RR: 0.65 [95% CI: 0.44–0.96]; <i>p</i> = 0.03), hospitalization for heart failure (RR: 0.27 [95% CI: 0.13–0.54]; <i>p</i> < 0.01), and stroke (RR: 0.62 [95% CI: 0.40–0.95]; <i>p</i> = 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]; <i>p</i> = 0.09), repeated aortic-valve surgery (RR: 0.74 [95% CI: 0.12–4.78]; <i>p</i> = 0.75), and thromboembolic complications (RR: 0.72 [95% CI: 0.23–2.21]; <i>p</i> = 0.56).</p><p><b>Conclusion:</b> 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. 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However, the preferred strategy for asymptomatic severe AS remains unclear. We compared early aortic valve replacement (eAVR) with conservative care.</p><p><b>Methods:</b> 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.</p><p><b>Results:</b> 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]; <i>p</i> = 0.13). However, early intervention was markedly associated with a lower incidence of cardiovascular mortality (RR: 0.65 [95% CI: 0.44–0.96]; <i>p</i> = 0.03), hospitalization for heart failure (RR: 0.27 [95% CI: 0.13–0.54]; <i>p</i> < 0.01), and stroke (RR: 0.62 [95% CI: 0.40–0.95]; <i>p</i> = 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]; <i>p</i> = 0.09), repeated aortic-valve surgery (RR: 0.74 [95% CI: 0.12–4.78]; <i>p</i> = 0.75), and thromboembolic complications (RR: 0.72 [95% CI: 0.23–2.21]; <i>p</i> = 0.56).</p><p><b>Conclusion:</b> 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. 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引用次数: 0
摘要
背景：主动脉瓣狭窄（AS）常见于老年人。然而，对于无症状严重AS的首选策略仍不清楚。我们比较了早期主动脉瓣置换术（eAVR）和保守治疗。方法：我们对截至2024年12月20日的主要数据库的rct进行了系统回顾和荟萃分析。使用R版本4.3将风险比（RRs）和平均差异（MDs）与95%置信区间（ci）合并。结果：4项rct（1427例）显示，早期干预与保守治疗的全因死亡率无显著差异（RR: 0.69 [95% CI: 0.42-1.11]; p = 0.13）。然而，与保守治疗相比，早期干预与较低的心血管死亡率（RR: 0.65 [95% CI: 0.44-0.96]; p = 0.03）、因心力衰竭住院（RR: 0.27 [95% CI: 0.13-0.54]; p < 0.01）和卒中（RR: 0.62 [95% CI: 0.40-0.95]; p = 0.03）发生率显著相关。此外，两组在心肌梗死（RR: 0.22 [95% CI: 0.04-1.24]; p = 0.09）、重复主动脉瓣手术（RR: 0.74 [95% CI: 0.12-4.78]; p = 0.75）和血栓栓塞并发症（RR: 0.72 [95% CI: 0.23-2.21]; p = 0.56）方面无显著差异。结论：在无症状的严重AS患者中，与保守治疗相比，早期AVR并没有降低总死亡率，但显著降低心血管死亡率、心力衰竭住院率和卒中风险。两组围手术期并发症相似。
Early Aortic Valve Replacement vs. Conservative Therapy in Asymptomatic Severe Aortic Stenosis Patients: A Meta-Analysis
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.
期刊介绍：
Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide.
With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery.
In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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