Comparison of One-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)

• Published in: The American journal of cardiology
• Main Authors: González Saldivar, Hugo, MD, Rodriguez-Pascual, Carlos, MD, PhD, de la Morena, Gonzalo, MD, Fernández-Golfín, Covadonga, MD, PhD, Amorós, Carmen, MD, Baquero Alonso, Mario, MD, Martínez Dolz, Luis, MD, Ariza Solé, Albert, MD, PhD, Guzmán-Martínez, Gabriela, MD, Gómez-Doblas, Juan José, MD, PhD, Arribas Jiménez, Antonio, MD, Fuentes, María Eugenia, MD, Galian Gay, Laura, MD, Ruiz Ortiz, Martin, MD, PhD, Avanzas, Pablo, MD, PhD, Abu-Assi, Emad, MD, Ripoll-Vera, Tomás, MD, Díaz-Castro, Oscar, MD, PhD, Pozo Osinalde, Eduardo, MD, PhD, Martínez-Sellés, Manuel, MD, PhD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Cardiovascular; aortic stenosis; aortic valve replacement; TAVI; prognosis
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.04.044

Abstract 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 multicentre registry that enrolled all consecutive adults with severe AS during a one-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, 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 (OR 2.7, 95% CI 1.8-4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136 – 29.1%) and the presence comorbidity (128 – 27.4%). During 1-year follow-up 132 patients died (18.2%). The main causes of death were heart failure (60 – 45.5%) and non-cardiac diseases (46 – 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.