The management of patients with asymptomatic, severe aortic stenosis (AS) is controversial. Lim et al performed a meta-analysis to examine the impact on outcomes of aortic valve replacement (AVR) in patients with severe asymptomatic AS versus a symptom-driven intervention approach. Four observational studies were identified with a total of 1300 patients. Using a random-effects model, there was a trend towards reduced overall mortality in patients undergoing early AVR compared with a symptom-driven AVR approach (OR 0.54, 95% CI 0.26 to 1.12, p=0.1). There was no significant reduction in cardiac mortality or sudden death (OR 0.78, p=0.85, and OR 0.34, p=0.25, respectively).
The authors conclude, although there was a trend towards reduced overall mortality when comparing early AVR in patients with asymptomatic, severe AS to a symptom-driven AVR approach, there was no significant difference in cardiac mortality or sudden death. An individual approach focusing on individual risk stratification and operative mortality is required until more robust, randomised trial data are available.