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

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 cha...

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Published inThe 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
LanguageEnglish
Published New York, NY Mosby, Inc 01.06.2009
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Elsevier
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Abstract 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.
AbstractList 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. 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. 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. 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.
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.
OBJECTIVEMany 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.METHODSBetween 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.RESULTSNineteen 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.CONCLUSIONSymptomatic 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.
Author Goel, Sachin S., MD
Sola, Srikanth, MD, FACC
Savage, Robert M., MD
Rodriguez, L. Leonardo, MD, FACC
Halley, Carmel, MD
Wallace, Lee, MD
Tuzcu, E. Murat, MD, FACC
Svensson, Lars, MD, PhD
Schoenhagen, Paul, MD, FACC
Christofferson, Ryan, MD
Stewart, William, MD, FACC
Kalahasti, Vidyasagar, MD, FACC
Roselli, Eric, MD
Kapadia, Samir R., MD, FACC
Shishehbor, Mehdi H., DO, MPH
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Issue 6
Keywords 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
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Snippet Objective Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient...
Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient population...
OBJECTIVEMany high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient...
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StartPage 1430
SubjectTerms 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
Title Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement
URI https://www.clinicalkey.es/playcontent/1-s2.0-S0022522309000166
https://dx.doi.org/10.1016/j.jtcvs.2008.12.030
http://jtcs.ctsnetjournals.org/cgi/content/abstract/137/6/1430
https://www.ncbi.nlm.nih.gov/pubmed/19464460
https://search.proquest.com/docview/67275081
Volume 137
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