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Early Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis with Preserved Ejection Fraction
Session:
Posters (Sessão 6 - Écran 8) - Intervenção Coronária e Estrutural 5 - Intervenção Valvular
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:
Pósters Electrónicos
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 and preserved ejection fraction remains controversial.</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 with preserved ejection. </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 with preserved ejection fraction criteria. 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">: Eight studies were included in which two were randomized clinical trials. A total of 2672 patients were included, providing a 642 pooled death events (327 in early-AVR and 941 in watchful waiting). In our meta-analysis, early-AVR revealed a significant lower all-cause mortality (pooled OR, 0.39; 95% CI [0.30, 0.51], P< 0.01; I²=47%). Additionally, the early-AVR group presented a lower rate of cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P<0.01; I²=64%). Both strategies had similar rate of stroke (pooled OR, 1.30; 95% CI [0.39, 4.27], P=0.67; I²=0%) and myocardial infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28; I²=0%). Heart Failure hospitalizations presented a lower trend early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36; I²=36%).</span></span></span></span></p> <p><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 with preserved ejection fraction.</span></span></p>
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