Meta-analysis Of Early Surgical Versus Conservative Management Of Asymptomatic Aortic Stenosis

Objective to compare the results of surgical treatment and conservative treatment in patients with asymptomatic severe aortic valve stenosis(AS).Methods the databases of Pub Med,EMbase,The Cochrane Library,Webof Science,China knowledge Network,VIP and Wanfang were searched systematically to collect the comparison between early operation and conservative treatment in patients with severe asymptomatic AS.Hazard ratio(HR),95% confidence interval and relative risk(RR)were used as the effect index,which was statistically defined as P < 0.05.The risk ratio(HR),95% confidence interval and relative risk(RR)were used as the effect index.Results compared with conservative treatment,early surgery significantly reduced all-cause mortality(HR0.35;95%CI,0.26-0.46,P<0.0001),cardiovascular mortality(HR0.46;95%CI,0.37-0.58,P<0.00001),non-cardiovascular mortality(RR0.43;95%CI,0.34-0.55,P<0.00001),and risk of sudden cardiac death(RR0.32;95%CI,0.19-0.54).(P<0.0001),the risk of hospitalization of heart failure(RR0.20;95%CI,0.11-0.35,P < 0.00001).There was no significant difference in the risk of myocardial infarction(RR0.61;95%CI,0.31-1.18,P=0.14)and stroke(RR1.11;95%CI,0.74-1.68,P = 0.61)between the two groups.Conclusion in patients with severe asymptomatic AS,compared with patients with conservative treatment,early surgical intervention significantly reduced the risk of all-cause mortality,cardiovascular mortality,non-cardiovascular mortality,sudden cardiac death and hospitalization of heart failure.Although the results of this meta analysis support early surgical intervention,further large-scale randomized controlled trials are needed to determine the benefits of early surgical treatment.And consolidate the effective intervention of asymptomatic aortic valve stenosis and formulate the best management strategy.The team must consider parameters such as the general condition of the patient,laboratory,echocardiography,and cardiac MRI,which can predict the risks and benefits of each management strategy.