Abstract
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.
Highlights
The timing of surgical intervention is an immensely important decision for patients who have significant aortic valve disease
Studies that were referenced by the American Heart Association/American College of Cardiology (AHA/ACC) 2014 guidelines regarding the timing of aortic valve replacement/repair (AVR) for chronic aortic regurgitation (AR) are summarized in the Supplemental Table S1 [33,34,35,36,37,38,39,40,41,42,43,44,45,46]
The newer studies suggest that once chronic severe AR or aortic stenosis (AS) cause symptoms or left ventricular dysfunction, long-term survival decreases despite AVR
Summary
The timing of surgical intervention is an immensely important decision for patients who have significant aortic valve disease. Patients are concerned about the morbidity and mortality risks of valve intervention and want to avoid the poor long-term consequences of uncorrected aortic valve disease They wish to maintain or improve their level of activity and quality of life. The 2014 AHA/ACC guidelines in combination with the equivalent European guidelines [13] provide a framework for clinicians to make evidence-based decisions regarding timing of AVR Since their release, several studies have been published that examine timing of surgery for either AR or AS [8,14,15,16,17,18,19,20,21,22,23]. This review investigates the strength of these additional data, how they relate to the data that the 2014 guidelines were built upon, and whether the guidelines’ recommendations warrant revisiting and updating
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
