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dc.contributor.authorTsampasian, Vasiliki
dc.contributor.authorGrafton-Clarke, Ciaran
dc.contributor.authorGracia Ramos, Abraham Edgar
dc.contributor.authorAsimakopoulos, George
dc.contributor.authorGarg, Pankaj
dc.contributor.authorPrasad, Sanjay
dc.contributor.authorRing, Liam
dc.contributor.authorMcCann, Gerry P
dc.contributor.authorRudd, James
dc.contributor.authorDweck, Marc R
dc.contributor.authorVassiliou, Vassilios S
dc.date.accessioned2022-06-07T08:10:10Z
dc.date.available2022-06-07T08:10:10Z
dc.date.issued2022-05-12
dc.date.submitted2022-02-04
dc.identifier.otheropenhrt-2022-001982
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/337730
dc.description.abstractObjectives: The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies. Methods: PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were ‘asymptomatic’, ‘severe aortic stenosis’ and ‘intervention’. Results: Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I2 77%). Conclusion: This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention. PROSPERO registration number: CRD42022301037.
dc.languageen
dc.publisherBMJ Publishing Group
dc.subjectValvular heart disease
dc.subject1506
dc.subjectmeta-analysis
dc.subjectaortic diseases
dc.subjectaortic valve stenosis
dc.titleManagement of asymptomatic severe aortic stenosis: a systematic review and meta-analysis
dc.typeArticle
dc.date.updated2022-06-07T08:10:09Z
prism.issueIdentifier1
prism.publicationNameOpen Heart
prism.volume9
dc.identifier.doi10.17863/CAM.85139
dcterms.dateAccepted2022-04-05
rioxxterms.versionofrecord10.1136/openhrt-2022-001982
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.licenseref.startdate2022-05-12
dc.contributor.orcidTsampasian, Vasiliki [0000-0003-1534-7587]
dc.contributor.orcidGracia Ramos, Abraham Edgar [0000-0003-1842-2554]
dc.contributor.orcidMcCann, Gerry P [0000-0002-5542-8448]
dc.identifier.eissn2053-3624
rioxxterms.freetoread.startdate2022-05-12
rioxxterms.freetoread.startdate2022-05-12


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