Objectives: Patients with severe, but asymptomatic aortic stenosis (AS) present a difficult clinical challenge. The conventional strategy is 'wait for symptoms' approach. However, some observational studies have suggested early aortic valve replacement (AVR) results in better outcome compared to late surgery. There are no randomised controlled trials comparing clinical outcome of early and late AVR. This meta-analysis is to examine the effect of the two approaches on clinical outcome in such patients. Methods: We searched the PubMed for published studies on asymptomatic AS and treatment. Four observational studies (N = 976 patients) were suitable for inclusion in the analysis. Results: All four studies provided sufficient details. Using the subgroup of asymptomatic patients who underwent early surgery together or separately from the subgroup who had surgery after developing symptoms resulted in ORs of 0.17 and 0.16 respectively (p < 0.00001) in favour of early AVR compared with conservational or late surgery. Conclusion: Meta-analysis of the available observational studies has demonstrated highly significant clinical outcome in favour of early AVR compared with late surgery, suggesting that early surgical approach offers substantial survival benefit for severe asymptomatic AS patients. (C) 2013 Elsevier Ireland Ltd. All rights reserved.