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. 2017 Jul 11;7(1):5092.
doi: 10.1038/s41598-017-05021-9.

Effects of Aortic Valve Replacement on Severe Aortic Stenosis and Preserved Systolic Function: Systematic Review and Network Meta-analysis

Qishi Zheng  1   2 , Andie H Djohan  3 , Enghow Lim  4 , Zee Pin Ding  4   5 , Lieng H Ling  6   7 , Luming Shi  1   2   4 , Edwin Shih-Yen Chan  1   2   4 , Calvin Woon Loong Chin  8   9
Affiliations

Effects of Aortic Valve Replacement on Severe Aortic Stenosis and Preserved Systolic Function: Systematic Review and Network Meta-analysis

Qishi Zheng et al. Sci Rep. .

Abstract

The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm2) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m2; normal-flow (NL) and low-flow (LF)]. Network meta-analysis was conducted to assess all-cause mortality among each AS sub-type with rate ratio (RR) reported. The effects of AVR on prognosis were examined using network meta-regression. In the pooled analysis (15 studies and 9,737 patients), LF states (both HG and LG) were associated with increased mortality rate (LFLG: RR 1.88; 95% CI: 1.43-2.46; LFHG: RR: 1.77; 95% CI: 1.16-2.70) compared to moderate AS; and NF states in both HG and LG had similar prognosis as moderate AS (NFLG: RR 1.11; 95% CI: 0.81-1.53; NFHG: RR 1.16; 95% CI: 0.82-1.64). AVR conferred different survival benefits: it was most effective in NFHG (RR with AVR /RR without AVR : 0.43; 95% CI: 0.22-0.82) and least in LFLG (RR with AVR /RR without AVR : 1.19; 95% CI: 0.74-1.94).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
PRISMA flowchart of study selection. The systematic review and meta-analysis was conducted according to the guidelines recommended by PRISMA.
Figure 2
Figure 2
Network geometry of the different flow-gradient states of severe aortic stenosis and preserved systolic ejection fraction.
Figure 3
Figure 3
Cumulative probability curves for prognosis for each group with SUCRA values.
Figure 4
Figure 4
Forest plots with results from consistency (red diamond) and inconsistency (green diamond) model.
Figure 5
Figure 5
Effects of AVR on the different flow-gradient states of severe aortic stenosis.
Figure 6
Figure 6
Direct comparisons of the effects of AVR versus medical therapy on the different flow-gradient states.
See this image and copyright information in PMC

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