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Survival after aortic valve replacement vs. conservative management in severe low-flow, low-gradient aortic stenosis
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  • Linda Renata Micali,
  • Salma Emad Algaroosh,
  • Orlando Parise,
  • Francesco Matteucci,
  • Gianmarco Parise,
  • Monique de Jong,
  • Amalia Ioanna Moula,
  • Cecilia Tetta,
  • Sandro Gelsomino
Linda Renata Micali
Maastricht University
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Salma Emad Algaroosh
Maastricht University
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Orlando Parise
Maastricht University
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Francesco Matteucci
Maastricht University
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Gianmarco Parise
Maastricht University
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Monique de Jong
Maastricht University
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Amalia Ioanna Moula
Maastricht University
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Cecilia Tetta
Maastricht University
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Sandro Gelsomino
Maastricht University
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Abstract

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.

Peer review status:IN REVISION

25 Apr 2020Submitted to Journal of Cardiac Surgery
18 Jun 2020Submission Checks Completed
18 Jun 2020Assigned to Editor
23 Jun 2020Reviewer(s) Assigned
29 Jun 2020Review(s) Completed, Editorial Evaluation Pending
08 Jul 2020Editorial Decision: Revise Major
29 Jul 20201st Revision Received
30 Jul 2020Submission Checks Completed
30 Jul 2020Assigned to Editor
01 Aug 2020Reviewer(s) Assigned
16 Aug 2020Review(s) Completed, Editorial Evaluation Pending
25 Aug 2020Editorial Decision: Revise Minor
16 Sep 20202nd Revision Received
22 Sep 2020Assigned to Editor
22 Sep 2020Submission Checks Completed