Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 137; no. 6; pp. 1430 - 1435
• Main Authors: Kapadia, Samir R., MD, FACC, Goel, Sachin S., MD, Svensson, Lars, MD, PhD, Roselli, Eric, MD, Savage, Robert M., MD, Wallace, Lee, MD, Sola, Srikanth, MD, FACC, Schoenhagen, Paul, MD, FACC, Shishehbor, Mehdi H., DO, MPH, Christofferson, Ryan, MD, Halley, Carmel, MD, Rodriguez, L. Leonardo, MD, FACC, Stewart, William, MD, FACC, Kalahasti, Vidyasagar, MD, FACC, Tuzcu, E. Murat, MD, FACC
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.2009; AATS/WTSA; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Cardiothoracic Surgery; Catheterization; Endocardial and cardiac valvular diseases; Female; Heart; Heart Valve Prosthesis Implantation - methods; Hospital Mortality; Humans; Length of Stay; Male; Medical sciences; Pneumology; Postoperative Complications; Survival Rate; Treatment Outcome; REVIVAL; 35; MR; mitral regurgitation; PAVR; balloon aortic valvuloplasty; SAVR; AS; aortic stenosis; STS; BAV; Society of Thoracic Surgeons; Transcatheter Endovascular Implantation of Valves; percutaneous aortic valve replacement; surgical aortic valve replacement; Human; Aortic stenosis; Prognosis; Cardiovascular disease; Patient; Heart valve; Percutaneous route; Characterization; Treatment; Cardiac valvular disease; Surgery; Anesthesia; Evolution; Circulatory system; Cardiology; Severe; Aortic valve
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2008.12.030

Objective Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient population remains ill-defined, many of these patients are now being referred for percutaneous aortic valve replacement. We sought to define the characteristics and outcomes of patients referred for percutaneous aortic valve replacement. Methods Between February 2006 and March 2007, 92 patients were screened for percutaneous aortic valve replacement. Clinical and echocardiographic characteristics of patients undergoing surgical aortic valve replacement, percutaneous aortic valve replacement, balloon aortic valvuloplasty, or no intervention were compared. The primary end point was all-cause mortality. Results Nineteen patients underwent successful surgical aortic valve replacement, 18 patients underwent percutaneous aortic valve replacement, and 36 patients had no intervention. Thirty patients underwent balloon aortic valvuloplasty, and of these, 8 patients were bridged to percutaneous aortic valve replacement and 3 were bridged to surgical aortic valve replacement. Of the remaining 19 patients undergoing balloon aortic valvuloplasty, bridging to percutaneous aortic valve replacement could not be accomplished because of death (n = 9 [47%)], exclusion from the percutaneous aortic valve replacement protocol (n = 6 [32%]), and some patients improved after balloon aortic valvuloplasty and declined percutaneous aortic valve replacement (n = 4 [21%]). The most common reasons for no intervention included death while awaiting definitive treatment (n = 10 [28%]), patient uninterested in percutaneous aortic valve replacement (n = 10 [28%]), and questionable severity of symptoms or aortic stenosis (n = 9 [25%]). Patients not undergoing aortic valve replacement had higher mortality compared with those undergoing aortic valve replacement (44% vs 14%) over a mean duration of 220 days. Conclusion Symptomatic patients with severe aortic stenosis have high mortality if timely aortic valve replacement is not feasible. Twenty percent of the patients referred for percutaneous aortic valve replacement underwent surgical aortic valve replacement with good outcome. Patients undergoing balloon aortic valvuloplasty alone or no intervention had unfavorable outcomes.