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Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

Jason P Koerber1, Jayme S Bennetts2,3, Peter J Psaltis4,5,6

  • 1Department of Anaesthesia, Flinders Medical Centre, Adelaide, SA 5042, Australia.

Journal of Clinical Medicine
|August 23, 2020
PubMed

Insights

Earlier aortic valve surgery for aortic regurgitation (AR) and aortic stenosis (AS) may improve long-term survival. Current guidelines might recommend delayed intervention, but recent studies suggest earlier surgery benefits patients with severe AR and AS.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes Research

Background:

  • The optimal timing for aortic valve intervention in chronic aortic regurgitation (AR) and aortic stenosis (AS) impacts long-term survival.
  • The 2014 AHA/ACC guidelines offer recommendations, but recent studies question if earlier intervention provides survival benefits.

Purpose of the Study:

  • To review existing literature and determine if earlier aortic valve surgery for chronic AR and/or AS offers a survival advantage.
  • To synthesize evidence from randomized controlled trials (RCTs) and observational studies published post-2015.

Main Methods:

  • Systematic literature search of medical databases (January 2015 - April 2020).
  • Inclusion of RCTs and observational studies evaluating aortic valve replacement timing for AR, AS, and mixed aortic valve disease (MAVD).
  • Analysis of identified studies to assess survival outcomes related to surgical timing.

Main Results:

  • Four observational studies on AR and six studies (including one RCT and one meta-analysis) on AS were identified.
  • One observational study included patients with mixed aortic valve disease (MAVD).
  • All reviewed studies indicated a long-term survival benefit for earlier aortic valve surgery compared to current guideline recommendations.

Conclusions:

  • Evidence suggests that earlier aortic valve surgery for AR, AS, and MAVD may improve long-term survival.
  • Current guidelines may not reflect the full survival benefit of timely intervention.
  • Larger prospective randomized controlled trials are needed to definitively confirm the benefits of earlier surgical intervention.

Keywords:
aortic regurgitationaortic stenosisaortic valve replacementmixed aortic valve diseasesurvivaltranscatheter aortic valve implantationvalvular heart disease

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