{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:31:32Z","timestamp":1775644292945,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2022,9,26]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Timing of intervention for patients with asymptomatic severe aortic stenosis (AS) remains controversial. To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in patients with asymptomatic severe AS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for studies comparing early AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis was performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twelve studies were included in which two were randomised clinical trials. A total of 4130 patients were included, providing a 1092 pooled death events. Our meta-analysis showed a significantly lower all-cause mortality for the early AVR compared with WW group, although with a high amount of heterogeneity between studies in the magnitude of the effect (pooled OR 0.40; 95% CI 0.35 to 0.45, p&lt;0.01; I\u00b2=61%). An early surgery strategy displayed a significantly lower cardiovascular mortality (pooled OR 0.33; 95% CI 0.19 to 0.56, p&lt;0.01; I\u00b2=64%) and heart failure hospitalisation (pooled OR 0.19; 95% CI 0.10 to 0.39, p&lt;0.01, I\u00b2=7%). However, both groups had similar rates of stroke (pooled OR 1.30; 95% CI 0.73 to 2.29, p=0.36, I\u00b2=0%) and myocardial infarction (pooled OR 0.49; 95% CI 0.19 to 1.27, p=0.14, I\u00b2= 0%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study suggests that for patients with asymptomatic severe AS an early surgical intervention compared with a conservative WW strategy was associated with a lower heart failure hospitalisation and a similar rate of stroke or myocardial infarction, although with significant risk of bias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42021291144.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2022-321411","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T13:21:48Z","timestamp":1664976108000},"page":"314-321","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Early surgical intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"109","clinical-trial-number":[{"clinical-trial-number":"nct01161732","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02436655","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03042104","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03094143","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03972644","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04204915","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6510-3690","authenticated-orcid":false,"given":"Gon\u00e7alo Nuno Ferraz","family":"Costa","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Cardiologia, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4037-0968","authenticated-orcid":false,"given":"Jo\u00e3o Fernandes Lopes","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Centro Hospitalar de Vila Nova de Gaia, Servi\u00e7o de Cirurgia Cardio-tor\u00e1cica, Vila Nova de Gaia, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7836-8161","authenticated-orcid":false,"given":"B\u00e1rbara","family":"Oliveiros","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9255-3064","authenticated-orcid":false,"given":"Lino","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4998-2247","authenticated-orcid":false,"given":"Rogerio","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"2025092007122085000_109.4.314.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041080"},{"key":"2025092007122085000_109.4.314.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.08.053"},{"key":"2025092007122085000_109.4.314.3","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1001\/jamacardio.2020.2497","article-title":"Natural history of asymptomatic severe aortic stenosis and the association of early intervention with outcomes: a systematic review and meta-analysis","volume":"5","author":"Gahl","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2025092007122085000_109.4.314.4","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.15420\/ecr.2021.11","article-title":"Timing of intervention in asymptomatic patients with aortic stenosis","volume":"16","author":"Sevilla","year":"2021","journal-title":"Eur Cardiol"},{"key":"2025092007122085000_109.4.314.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"2025092007122085000_109.4.314.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.495903"},{"key":"2025092007122085000_109.4.314.7","doi-asserted-by":"crossref","unstructured":"Otto CM , Nishimura RA , Bonow RO , et al . 2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American heart association joint Committee on clinical practice guidelines. 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