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Early Aortic Valve Replacement versus Conservative Management in Asymptomatic Severe Aortic Stenosis
Session:
Comunicações Orais (Sessão 7) - Intervenção Cardíaca Coronária e Estrutural 1 - Válvula Aórtica
Speaker:
Gonçalo Ferraz Costa
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
22.4 Aortic Disease - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gonçalo Ferraz Costa; João Lopes Cardoso; Lino Gonçalves; Rogério Teixeira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Background</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">: Aortic stenosis (AS) is the most common valvular disease in developed countries. Specific timing of intervention for asymptomatic patients with severe aortic stenosis.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Purpose</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">: To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic AS patients</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">: </span></span><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Results</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">: Thirteen studies were included in which two were randomized clinical trials. A total of 4679 patients were included, providing a 1268 pooled death events (327 in early-AVR and 941 in watchful waiting). Our meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group, although with a moderate amount of heterogeneity between studies in the magnitude of effect (pooled OR, 0.41; 95% CI [0.34, 0.50], P< 0.01; I²=60%). early surgery strategy displayed a significant lower cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P< 0.01; I²=64%) and heart failure hospitalizations (pooled OR 0.19; 95% CI [0.10, 0.39], P< 0.01, I²=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI [0.73, 2.29], P= 0.36, I²=0%) and myocardial infarction (pooled OR 0.49; 95% CI [0.19, 1.27], P= 0.14, I²=0%). In terms of Major Adverse Cardiac Events, early AVR presented a lower rate of events (pooled OR 0.43; 95% CI [0.21, 0.87], P= 0.02, I²=50%).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Conclusion</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">: </span></span><span style="font-size:10.0pt"><span style="font-family:"Bahnschrift SemiLight",sans-serif">Our pooled data suggests that early-AVR strategy is preferable for asymptomatic severe AS patients.</span></span></span></span></p>
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