Survival after aortic valve replacement vs. conservative management in
severe low-flow, low-gradient aortic stenosis
Background and aim. Classical and paradoxical low-flow, low-gradient
aortic stenosis (LFLGAS) are the most challenging aortic stenosis (AS)
subtypes. The current therapeutic options are aortic valve replacement
(AVR) and conservative management. The matter is controversial because
AVR promotes long-term survival, but it is invasive, while no aortic
valve replacement (noAVR) in non-invasive, but it is associated with
poor prognosis. This meta-analysis aims to investigate the survival rate
in patients with LFLGAS undergoing AVR versus noAVR interventions.
Methods. A meta-analysis was conducted comparing the outcomes of AVR and
noAVR in terms of survival. A meta-regression was carried out to
investigate the impact of preserved and reduced left ventricular
ejection fraction (LVEF) on survival in both the AVR and noAVR group.
Results. The log IRR of survival between AVR group and noAVR group was
0.58 [0.28, 0.87] (p-value = 0.0001), suggesting that survival is
significantly better in the AVR group compared to the noAVR group. The
meta-regression revealed that low LVEF is related to higher survival
rates in the AVR group (p-value = 0.04) when compared to preserved LVEF.
LVEF has no impact on survival in the noAVR group (p-value = 0.18).
Conclusions. Patients with LFLGAS have better survival in the AVR group
rather than in the noAVR group. Reduced LVEF was related to better
survival than preserved LVEF in the AVR, and no difference between low
and preserved LVEF was found in the noAVR group.