Abstract 4368068: Is Earlier Better? Comparative Outcomes of Early Valve Replacement versus Conservative Management in Asymptomatic Severe Aortic Stenosis: A Systematic Review and Meta-analysis

Abstract

Background: Aortic stenosis (AS) is the most common valvular heart disease, with a growing burden of patients presenting with severe yet asymptomatic disease. The US FDA recently approved TAVI for asymptomatic severe AS based on findings of the EARLY TAVR trial. We aimed to compare the clinical outcomes of early valve replacement and conservative management in patients with asymptomatic severe AS. Methodology: A systematic literature search was conducted to identify studies comparing early replacement with conservative management in patients with asymptomatic severe AS. Primary outcomes included all-cause mortality, cardiac-related hospitalizations, and stroke. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method under a random-effects model. Heterogeneity was assessed using the I 2 statistic. Statistical analyses were performed using R version 4.4.2. Results: Five studies (four randomized controlled trials and one observational study) encompassing 5,242 patients met inclusion criteria. Early valve replacement was associated with a significant reduction in all-cause mortality compared to conservative management (RR: 0.66; 95% CI: 0.45–0.98; P = 0.0339). Cardiac-related hospitalizations were also significantly reduced in the early intervention group (RR: 0.31; 95% CI: 0.16–0.61; P = 0.0106). Additionally, early intervention was associated with a lower risk of stroke (RR: 0.59; 95% CI: 0.37–0.92; P = 0.021). Conclusion: Early intervention in asymptomatic severe AS is associated with lower all-cause mortality, fewer cardiac-related hospitalizations, and reduced stroke risk compared to standard care. These findings support the consideration of earlier treatment strategies to mitigate long-term adverse outcomes in this population.