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)

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 follo...

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Published in:	The American journal of cardiology Vol. 118; no. 2; pp. 244 - 250
Main Authors:	González-Saldivar, Hugo, Rodriguez-Pascual, Carlos, de la Morena, Gonzalo, Fernández-Golfín, Covadonga, Amorós, Carmen, Dolz, Luis Martínez, Solé, Albert Ariza, Guzmán-Martínez, Gabriela, Gómez-Doblas, Juan José, Fuentes, María Eugenia, Gay, Laura Galian, Ortiz, Martin Ruiz, Avanzas, Pablo, Abu-Assi, Emad, Díaz-Castro, Oscar, Osinalde, Eduardo P., Martínez-Sellés, Manuel, Saldivar, Hugo González, Parajes-Vazquez, Teresa, De la Morena, Gonzalo, Flores-Blanco, Pedro J., Lozano, Cristina, Rincón, Luis Miguel, Borras, Xavier, Alonso, Mario Baquero, Camacho, Eva García, Pérez, Andrés Sánchez, Climent, Herminio Morillas, Sánchez, Jorge Sanz, Vallverdú, María Ferré, González-Fernández, Óscar, Jiménez, Antonio Arribas, Garcia Sánchez, Maria Jesús, Sánchez Fernandez, Pedro Luis, Millán, María Victoria, Pascual, Isaac, Morís, César, Vera, Tomás Ripoll, Pérez, Yolanda Gómez, Diaz-Castro, Oscar, Borreguero, Jesús Jimenez, Pozo, Eduardo, Antuña, Paula, Viliani, Dafne, Mogollón Jiménez, María Victoria, Gómez, Gonzalo Marcos, García, Marcelino Cortés, Orejas, Miguel Orejas, Quiles, Juan, Castrodeza, Javier, Tobar, Javier, López, Javier, Garcia Gonzalez, Martin Jesús, Labrador, Eva Bernal, Ayerbe, Jorge López, Barros, Sonia María, Ruiz, Antoni Carol, Botas, Javier, Caro Martinez, Cesar S., Aguera, Alicia Gómez, Sierra, Teresa Pareja, Yarcuri, Fiorella Quinte, Rodriguez, Irene Mateo, Martínez, Maria del Pilar Zuazola, Pérez, Teresa, Garri, Francisco Sogorb, Ramirez-Marrero, Miguel A., Campaña, Sonia Ibars, Marchan, Ferrán Padilla, Rodríguez-Capitán, Jorge, Andion, Ramón, de Isla, Leopoldo Pérez, Casado, Patricia Mahía, Carrera, José Plaza, de la Villa Redondo, Bernardo García, Valencia-Serrano, Félix M., Bustos, Daniel Bravo, Lacambra-Blasco, Isaac, Isasti, Guillermo, Paves, Alicia Bautista, Pereyra, Eduardo, Pueo, Eva, Santos, Luis Cornide, Martín, Ana Garrido, Lozano, Clara Bonanad, Diaz, Javier Lopez, Calvo, Javier Castrodeza, Ruiz, Javier Tobar
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 15-07-2016 Elsevier Limited
Subjects:	Age Aged Aged, 80 and over Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - epidemiology Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - therapy Asymptomatic Diseases Clinical Decision-Making Comorbidity Conservative Treatment Decision making Echocardiography Female Heart Failure - mortality Heart surgery Hospitals Humans Intervention Male Medical prognosis Morbidity Mortality Odds Ratio Prognosis Registries Severity of Illness Index Spain Stroke Volume Survival Rate Tertiary Care Centers Transcatheter Aortic Valve Replacement Treatment Outcome Variables Womens health
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/j.amjcard.2016.04.044