Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 May;9(1):e001982.
doi: 10.1136/openhrt-2022-001982.

Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis

Vasiliki Tsampasian  1   2 , Ciaran Grafton-Clarke  3   2 , Abraham Edgar Gracia Ramos  4   5 , George Asimakopoulos  6   7 , Pankaj Garg  3   2 , Sanjay Prasad  6   7 , Liam Ring  8 , Gerry P McCann  9   10 , James Rudd  11 , Marc R Dweck  12 , Vassilios S Vassiliou  3   2
Affiliations
Meta-Analysis

Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis

Vasiliki Tsampasian et al. Open Heart. 2022 May.

Abstract

Objectives: The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies.

Methods: PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were 'asymptomatic', 'severe aortic stenosis' and 'intervention'.

Results: Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I2 77%).

Conclusion: This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention.

Prospero registration number: CRD42022301037.

Keywords: aortic diseases; aortic valve stenosis; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Meta-analysis of AVATAR and RECOVERY trials focusing on all-cause mortality: the effect of early intervention on all-cause mortality. AVATAR, Aortic Valve Replacement versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis. RECOVERY, Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis; IV, interval variable; Tx, treatment.
Figure 2
Figure 2
Meta-analysis of AVATAR and RECOVERY trials focusing on hospitalisation for heart failure. Early intervention resulted in significant risk reduction of hospitalisation for heart failure. AVATAR, Aortic Valve Replacement versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis. RECOVERY, Randomized Comparison of Early Surgery versus Conventional Treatment in Very Severe Aortic Stenosis. IV, interval variable; Tx, treatment.
Figure 3
Figure 3
Meta-analysis of observational studies: impact of early aortic valve intervention versus conservative management on all-cause mortality. IV, interval variable; Mx, management.
See this image and copyright information in PMC

References

    1. Coffey S, Cairns BJ, Iung B. The modern epidemiology of heart valve disease. Heart 2016;102:75–85. 10.1136/heartjnl-2014-307020 - DOI - PubMed
    1. Coffey S, Cox B, Williams MJA. Lack of progress in valvular heart disease in the pre-transcatheter aortic valve replacement era: increasing deaths and minimal change in mortality rate over the past three decades. Am Heart J 2014;167:562–7. 10.1016/j.ahj.2013.12.030 - DOI - PubMed
    1. Vahanian A, Beyersdorf F, Praz F, et al. . 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022;43:561–632. 10.1093/eurheartj/ehab395 - DOI - PubMed
    1. Otto CM, Nishimura RA, Bonow RO, et al. . 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e72–227. 10.1161/CIR.0000000000000923 - DOI - PubMed
    1. Bing R, Everett RJ, Tuck C, et al. . Rationale and design of the randomized, controlled early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe aortic stenosis (EVOLVED) trial. Am Heart J 2019;212:91–100. 10.1016/j.ahj.2019.02.018 - DOI - PubMed

Publication types

MeSH terms