Objective:

To evaluate the efficacy and safety of early aortic valve replacement (AVR) compared to clinical surveillance (CSV) in patients with asymptomatic severe aortic stenosis (AS).

Approach:

Key Findings:

• Early AVR was associated with significant reduction in major adverse cardiovascular events (MACE) (OR: 0.41, 95% CI: 0.29–0.59, P < 0.001).
• Early AVR reduced all-cause mortality (OR: 0.59, 95% CI: 0.39–0.88, P = 0.011) and cardiovascular mortality (OR: 0.49, 95% CI: 0.35–0.69, P < 0.001).
• Hospitalization for heart failure was significantly lower in the AVR group (OR: 0.36, 95% CI: 0.20–0.65, P < 0.001).
• Major vascular bleeding occurred more frequently in the early AVR group (OR: 1.75, 95% CI: 1.05–2.92, P = 0.032).
• No significant differences in myocardial infarction, stroke, pacemaker implantation, or infective endocarditis between groups.

Interpretation:

Early AVR in asymptomatic severe AS patients is associated with reduced heart failure hospitalization and improved safety outcomes compared to CSV.

Limitations:

• Heterogeneous results from recent randomized trials.
• Variability in observational data and potential confounding factors.
• Limited comparative interpretation between randomized and real-world evidence.

Conclusion:

The findings support a more individualized approach to the timing of intervention in asymptomatic severe AS patients.

Sources:

• Systematic Review Registration
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