Early Aortic Valve Replacement Versus Conservative Management: A Meta-Analysis of Randomized Controlled Trials

TL;DR

Replacing aortic valves early before severe symptoms may not improve most outcomes but could reduce stroke risk.

Contribution

A meta-analysis comparing early aortic valve replacement with conservative management reveals stroke benefits but unclear mechanisms.

Findings

Early aortic valve replacement does not improve mortality or myocardial infarction outcomes.

Early replacement is associated with a reduced risk of stroke.

Younger patients and women may benefit more from early replacement, though this needs further study.

Abstract

•Early aortic valve replacement before the development of severe symptomatic aortic stenosis is not associated with a benefit for most hard endpoints including mortality and myocardial infarction but is associated with a benefit in stroke.•The mechanism for the potential benefit of early aortic valve replacement on stroke remains unclear.•Younger patients and women may derive a mortality benefit from early aortic valve replacement, but this warrants further study.

Early aortic valve replacement before the development of severe symptomatic aortic stenosis is not associated with a benefit for most hard endpoints including mortality and myocardial infarction but is associated with a benefit in stroke.

The mechanism for the potential benefit of early aortic valve replacement on stroke remains unclear.

Younger patients and women may derive a mortality benefit from early aortic valve replacement, but this warrants further study.

Figures