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.