PT  - JOURNAL ARTICLE
AU  - Vasiliki Tsampasian
AU  - Ciaran Grafton-Clarke
AU  - Abraham Edgar Gracia Ramos
AU  - George Asimakopoulos
AU  - Pankaj Garg
AU  - Sanjay Prasad
AU  - Liam Ring
AU  - Gerry P McCann
AU  - James Rudd
AU  - Marc R Dweck
AU  - Vassilios S Vassiliou
TI  - Management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis
AID  - 10.1136/openhrt-2022-001982
DP  - 2022 May 01
TA  - Open Heart
PG  - e001982
VI  - 9
IP  - 1
4099  - http://openheart.bmj.com/content/9/1/e001982.short
4100  - http://openheart.bmj.com/content/9/1/e001982.full
SO  - Open Heart2022 May 01; 9
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information.