Valvular Heart Disease
Comparison of 1-Year Outcome in Patients With Severe Aorta Stenosis Treated Conservatively or by Aortic Valve Replacement or by Percutaneous Transcatheter Aortic Valve Implantation (Data from a Multicenter Spanish Registry)

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The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.

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Methods

Influencia del Diagnóstico de Estenosis Aórtica Severa (IDEAS)—Influence of the Severe Aortic Stenosis Diagnosis—is a multicenter registry that enrolled all consecutive adults diagnosed with severe AS (mean gradient >40 mm Hg or valve area <1 cm2) in the echocardiographic laboratory of 48 Spanish centers, during January 2014.

The only exclusion was any previous aortic valve intervention, including valvuloplasty, AVR, and TAVI. Informed consent was obtained. Variables registered included clinical

Results

A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management strategy was conservative therapy in 468 (64.5%), followed by AVR in 199 (27.4%), and TAVI in 59 (8.1%). Table 1 lists the comparison of clinical and echocardiographic data according to management. Patients treated with AVR were younger, with less co-morbidity, and lower surgical risk than patients managed without open-heart surgery. They also presented higher creatinine

Discussion

In our population with severe AS, the most common management strategy was conservative therapy. The decision to perform aortic valve intervention was more frequent in tertiary hospitals than in small regional centers. Patients managed with AVR had the lowest risk profile of the 3 groups. TAVI seems to be particularly beneficial for patients with high co-morbidity or high surgical risk.

Recent studies have shown that patients with severe AS are frequently treated conservatively,9, 10, 11, 12 even

Disclosures

The authors have no conflicts of interest to disclose.

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