Aortic valve replacement versus conservative management for asymptomatic severe aortic stenosis with preserved left...

The merits of conservative management versus aortic valve replacement (AVR) in patients with asymptomatic severe aortic stenosis (AS) remain unknown. We conducted a comprehensive search across PubMed, Cochrane Central, and Scopus from March 1975 until December 2024 for studies comparing AVR vs conservative management in asymptomatic severe AS patients with preserved left ventricular ejection fraction (LVEF). Outcomes were analyzed using a random-effects model to pool odds ratios (ORs) with 95% confidence intervals (CIs). Our pooled analysis included four randomized controlled trials (RCTs) encompassing a total of 1427 patients. AVR significantly reduced the incidence of major adverse cardiovascular and cerebral events (MACCEs) (OR 0.36; 95% CI 0.22-0.61; p = 0.0002) compared to conservative management. The incidence of all-cause mortality, 30-day peri-procedural mortality, cardiovascular mortality, and myocardial infarction was comparable between the two groups. AVR was associated with a significant reduction in stroke incidence (OR 0.59; 95% CI 0.37-0.95, p = 0.03) and unplanned cardiovascular hospitalization rates (OR 0.35; 95% CI 0.27-0.46, p < 0.00001). AVR significantly reduces MACCEs, stroke, and unplanned cardiovascular hospitalizations compared to conservative management, with comparable mortality and myocardial infarction rates between the groups.

The online version contains supplementary material available at 10.1007/s12055-025-02070-y.