Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to...

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Bibliographic Details
Published in:Journal of clinical medicine Vol. 9; no. 9; p. 2694
Main Authors: Koerber, Jason P., Bennetts, Jayme S., Psaltis, Peter J.
Format: Journal Article
Language:English
Published: Basel MDPI AG 20-08-2020
MDPI
Subjects:
Aortic stenosis
Asymptomatic
Cardiac stress tests
Cardiology
Cardiovascular disease
Clinical medicine
Heart surgery
Life expectancy
Morbidity
Mortality
Review
Thoracic surgery
Thromboembolism
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Summary:Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to the guidelines’ release, several studies have been published that suggest a survival benefit from earlier timing of surgery for severe AR and/or AS. The aim of this review was to determine whether patients who have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a survival benefit from earlier timing of aortic valve surgery. Medical databases were systematically searched from January 2015 to April 2020 for randomized controlled trials (RCTs) and observational studies that examined the timing of aortic valve replacement surgery for chronic AR and/or AS. For chronic AR, four observational studies and no RCTs were identified. For chronic AS, five observational studies, one RCT and one meta-analysis were identified. One observational study examining mixed aortic valve disease (MAVD) was identified. All of these studies, for AR, AS, and MAVD, found long-term survival benefit from timing of aortic valve surgery earlier than the current guidelines. Larger prospective RCTs are required to evaluate the benefit of earlier surgical intervention.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-1
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9092694