Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients With Severe Aortic Stenosis: A Systematic Review and Meta-analysis.

The merits of conservative management vs early intervention in patients with asymptomatic severe aortic stenosis remains unknown. Digital databases (MEDLINE, Google Scholar, and Embase) were searched for all relevant studies from inception through September 2022. Studies comparing conservative management with early intervention were compared using a random-effects model to calculate risk ratios (RRs) with 95% confidence interval (CI). A total of 12 studies comprising 3624 asymptomatic aortic stenosis patients (1747 receiving surgery, and 1877 receiving conservative treatment) were included in the analysis. The average follow-up time was 4.45 (IQR 3.5-5) years. Early intervention was associated with a significantly reduced risk of cardiac (RR 0.42, 95% CI 0.25-0.72; P = 0.001; I = 54%), non-cardiac (RR 0.46, 95% CI 0.32-0.68; P < 0.0001; I = 0%), all-cause mortality (RR 0.40, 95% CI 0.32-0.51; P < 0.00001; I = 58%), heart failure hospitalization (RR 0.21, 95% CI 0.13-0.36; P < 0.00001; I = 0%), sudden cardiac death (RR 0.29, 95% CI 0.12-0.66; P = 0.004, I = 24%), and MACE (RR 0.46, 95% CI; 0.28-0.75; P = 0.002; I = 68%), compared with conservative management. There was no significant difference in the 30-day mortality (RR 0.63, 95% CI 0.19-2.04; P = 0.44; I = 28%), myocardial infarction (RR 0.44, 95% CI 0.19-1.06; P = 0.07, I=0%), and 90-day mortality (RR 0.68, 95% CI 0.20-2.37; P = 0.55; I = 61%) between the 2 groups. This meta-analysis shows statistically significant reductions in the risk for all-cause mortality, cardiac specific mortality, non-cardiac mortality, heart failure hospitalization, MACE, and sudden cardiac death among asymptomatic aortic stenosis patients who underwent early intervention as opposed to conservative management.