Introduction
Low-flow, low-gradient aortic
stenosis (LFLGAS) is the most challenging aortic stenosis (AS) subtype,
regardless of whether it is accompanied by either depressed left
ventricular ejection fraction (LVEF) or preserved LVEF1,2. The challenge derives from the inconsistency
between aortic valve area (AVA) and gradient, which does not allow a
realistic evaluation of the entity of the stenosis, fundamental in
choosing the right therapeutic approach 3.
Currently, the available therapeutic managements for LFLFAS are aortic
valve replacement (AVR) in symptomatic patients with left ventricular
(LV) dysfunction, and conservative management 4. AVR
promotes long-term survival and improvement of the functional status of
patients in both classical and paradoxical LFLGAS. Still, it is more
invasive, and it is associated with high operative mortality risk in
patients with reduced LV contractile reserve 4-7. On
the other hand, a noAVR approach mainly via medical management is
considered the treatment of choice in elderly patients and subjects with
high preoperative risk, as it is not invasive 8.
However, noAVR approaches predispose patients to a poorer prognosis in
both classical and paradoxical LFLGAS 8.
Since noAVR approach leads to a poor prognosis and AVR is burdened by a
high operative risk, literature reports controversial results about the
superiority of one type of management over the other.
Therefore, this meta-analysis aims to investigate the survival rate in
patients with LFLGAS undergoing AVR versus noAVR
interventions.