Ullah, W, Gowda, SN, Khan, MS, Sattar, Y, Al-Khadra, Y, Rashid, M ORCID: https://orcid.org/0000-0001-9725-1583, Mohamed, MO ORCID: https://orcid.org/0000-0002-9678-5222, Alkhouli, M, Kapadia, S, Bagur, R, Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890, Fischman, DL and Alraies, MC (2020) Early intervention or watchful waiting for asymptomatic severe aortic valve stenosis: a systematic review and meta-analysis. Journal of Cardiovascular Medicine, 21 (11). pp. 897-904.

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Abstract

BACKGROUND: The management of patients with severe but asymptomatic aortic stenosis is challenging. Evidence on early aortic valve replacement (AVR) versus symptom-driven intervention in these patients is unknown. METHODS: Electronic databases were searched, articles comparing early-AVR with conservative management for severe aortic stenosis were identified. Pooled adjusted odds ratio (OR) was computed using a random-effect model to determine all-cause and cardiovascular mortality. RESULTS: A total of eight studies consisting of 2201 patients were identified. Early-AVR was associated with lower all-cause mortality [OR 0.24, 95% confidence interval (CI) 0.13-0.45, P ≤ 0.00001] and cardiovascular mortality (OR 0.21, 95% CI 0.06-0.70, P = 0.01) compared with conservative management. The number needed to treat to prevent 1 all-cause and cardiovascular mortality was 4 and 9, respectively. The odds of all-cause mortality in a selected patient population undergoing surgical AVR (SAVR) (OR 0.16, 95% CI 0.09-0.29, P ≤ 0.00001) and SAVR or transcatheter AVR (TAVR) (OR 0.53, 95% CI 0.35-0.81, P = 0.003) were significantly lower compared with patients who are managed conservatively. A subgroup sensitivity analysis based on severe aortic stenosis (OR 0.24, 95% CI 0.11-0.52, P = 0.0004) versus very severe aortic stenosis (OR 0.20, 95% CI 0.08-0.51, P = 0.0008) also mirrored the findings of overall results. CONCLUSION: Patients with asymptomatic aortic valve stenosis have lower odds of all-cause and cardiovascular mortality when managed with early-AVR compared with conservative management. However, because of significant heterogeneity in the classification of asymptomatic patients, large scale studies are required.

Item Type: Article
Additional Information: The final version of this article and all relevant information can be found online at; https://journals.lww.com/jcardiovascularmedicine/Abstract/2020/11000/Early_intervention_or_watchful_waiting_for.9.aspx
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
R Medicine > RD Surgery
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 28 Jan 2021 15:19
Last Modified: 28 Jan 2021 15:19
URI: https://eprints.keele.ac.uk/id/eprint/8679

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