Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials
Background Asymptomatic severe aortic stenosis may lead to the progression to both symptoms and adverse outcomes if left untreated. The appropriate timing of intervention for these patients remains controversial, and any decision requires careful assessment. Methods We searched PubMed, Web of Scienc...
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Wiley
2025-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.125.041283 |
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| author | Qingchun Song Ruilin Liu Kai Yang Xiaokang Tu Haoyu Tan Chengming Fan Xiaoxiao Li |
| author_facet | Qingchun Song Ruilin Liu Kai Yang Xiaokang Tu Haoyu Tan Chengming Fan Xiaoxiao Li |
| author_sort | Qingchun Song |
| collection | DOAJ |
| description | Background Asymptomatic severe aortic stenosis may lead to the progression to both symptoms and adverse outcomes if left untreated. The appropriate timing of intervention for these patients remains controversial, and any decision requires careful assessment. Methods We searched PubMed, Web of Science, EMBASE, and Cochrane Library for randomized controlled trials comparing early aortic valve replacement with conservative management in asymptomatic patients with severe aortic stenosis until December 2024. The primary efficacy outcome was a composite of all‐cause mortality, hospitalization for cardiovascular causes, stroke, and myocardial infarction. We expressed outcome data as risk ratios (RRs) with 95% CIs. Results We included 4 randomized controlled trials involving 1427 patients. Early aortic valve replacement significantly reduced the incidence of the composite outcome when compared with conservative management (29.2% versus 53.7%; RR, 0.56 [95% CI, 0.49–0.64]; I2=60%). Significant reductions were also detected in all‐cause mortality (10.0% versus 13.7%; RR, 0.74 [95% CI, 0.55–0.99]; I2=58%), hospitalization for cardiovascular causes (14.6% versus 32.5%; RR, 0.48 [95% CI, 0.39–0.58]; I2=26%), and stroke (4.5% versus 7.2% RR, 0.62 [95% CI, 0.40–0.95]; I2=0%). No significant difference was observed in cardiac‐specific mortality (8.3% versus 16% RR, 0.68 [95% CI, 0.40–1.16]; I2=65%) and myocardial infarction (0.6% versus 4.6%; RR, 0.21 [95% CI, 0.04–1.19]; I2=0%). Conclusions Our meta‐analysis of randomized controlled trials showed that among patients with asymptomatic severe aortic stenosis, a strategy of early aortic valve interventions was superior to conservative treatments in reducing the primary composite outcome of all‐cause mortality, hospitalization for cardiovascular causes, stroke, and myocardial infarction. However, significant differences in the rates of cardiac‐specific mortality were not apparent. |
| format | Article |
| id | doaj-art-e90fe77312f341699e061fcc478772c0 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e90fe77312f341699e061fcc478772c02025-08-20T07:24:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-08-01141610.1161/JAHA.125.041283Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled TrialsQingchun Song0Ruilin Liu1Kai Yang2Xiaokang Tu3Haoyu Tan4Chengming Fan5Xiaoxiao Li6Department of Cardiovascular Surgery, The Second Xiangya Hospital Central South University Changsha Hunan ChinaDepartment of Cardiovascular Surgery, The Second Xiangya Hospital Central South University Changsha Hunan ChinaDepartment of Plastic and Aesthetic(Burn)Surgery, Second Xiangya Hospital Central South University Changsha ChinaDepartment of Cardiovascular Surgery, The Second Xiangya Hospital Central South University Changsha Hunan ChinaDepartment of Cardiovascular Surgery, The Second Xiangya Hospital Central South University Changsha Hunan ChinaDepartment of Cardiovascular Surgery, The Second Xiangya Hospital Central South University Changsha Hunan ChinaHunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University Changsha ChinaBackground Asymptomatic severe aortic stenosis may lead to the progression to both symptoms and adverse outcomes if left untreated. The appropriate timing of intervention for these patients remains controversial, and any decision requires careful assessment. Methods We searched PubMed, Web of Science, EMBASE, and Cochrane Library for randomized controlled trials comparing early aortic valve replacement with conservative management in asymptomatic patients with severe aortic stenosis until December 2024. The primary efficacy outcome was a composite of all‐cause mortality, hospitalization for cardiovascular causes, stroke, and myocardial infarction. We expressed outcome data as risk ratios (RRs) with 95% CIs. Results We included 4 randomized controlled trials involving 1427 patients. Early aortic valve replacement significantly reduced the incidence of the composite outcome when compared with conservative management (29.2% versus 53.7%; RR, 0.56 [95% CI, 0.49–0.64]; I2=60%). Significant reductions were also detected in all‐cause mortality (10.0% versus 13.7%; RR, 0.74 [95% CI, 0.55–0.99]; I2=58%), hospitalization for cardiovascular causes (14.6% versus 32.5%; RR, 0.48 [95% CI, 0.39–0.58]; I2=26%), and stroke (4.5% versus 7.2% RR, 0.62 [95% CI, 0.40–0.95]; I2=0%). No significant difference was observed in cardiac‐specific mortality (8.3% versus 16% RR, 0.68 [95% CI, 0.40–1.16]; I2=65%) and myocardial infarction (0.6% versus 4.6%; RR, 0.21 [95% CI, 0.04–1.19]; I2=0%). Conclusions Our meta‐analysis of randomized controlled trials showed that among patients with asymptomatic severe aortic stenosis, a strategy of early aortic valve interventions was superior to conservative treatments in reducing the primary composite outcome of all‐cause mortality, hospitalization for cardiovascular causes, stroke, and myocardial infarction. However, significant differences in the rates of cardiac‐specific mortality were not apparent.https://www.ahajournals.org/doi/10.1161/JAHA.125.041283aortic valve replacementasymptomaticmeta‐analysissevere aortic stenosis |
| spellingShingle | Qingchun Song Ruilin Liu Kai Yang Xiaokang Tu Haoyu Tan Chengming Fan Xiaoxiao Li Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve replacement asymptomatic meta‐analysis severe aortic stenosis |
| title | Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials |
| title_full | Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials |
| title_fullStr | Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials |
| title_short | Early Aortic Valve Replacement of Asymptomatic Severe Aortic Stenosis: A Meta‐Analysis of Randomized Controlled Trials |
| title_sort | early aortic valve replacement of asymptomatic severe aortic stenosis a meta analysis of randomized controlled trials |
| topic | aortic valve replacement asymptomatic meta‐analysis severe aortic stenosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.125.041283 |
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