Mortality While Waiting for Aortic Valve Replacement

• Published in: The Annals of thoracic surgery Vol. 98; no. 5; pp. 1564 - 1571
• Main Authors: Malaisrie, S. Chris, MD, McDonald, Eileen, RN, Kruse, Jane, RN, Li, Zhi, MS, McGee, Edwin C., MD, Abicht, Travis O., MD, Russell, Hyde, MD, McCarthy, Patrick M., MD, Andrei, Adin-Cristian, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-11-2014
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiac Catheterization; Cardiothoracic Surgery; Cause of Death - trends; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Severity of Illness Index; Surgery; Survival Rate - trends; Time Factors; Transcatheter Aortic Valve Replacement; United States - epidemiology; Waiting Lists - mortality; United States; CHF; aortic valve replacement; left ventricle; myocardial infarction; HR; LV; odds ratio; TAVR; New York Heart Association; atrial fibrillation; aortic stenosis; STS; overall survival; congestive heart failure; MI; BMI; coronary artery bypass grafting; NYHA; 35; OR; OS; AF; body mass index; CI; SAVR; The Society of Thoracic Surgeons; AS; hazard ratio; transcatheter aortic valve replacement; confidence interval; CABG; surgical aortic valve replacement; AVR; COPD; chronic obstructive pulmonary disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.06.040

Background Severe symptomatic aortic stenosis (AS) is associated with high mortality without intervention. The impact of waiting time for aortic valve replacement (AVR), either surgically or transcatheter, has not been reported. Methods From January 2008 to December 2012, we identified 1,005 patients with severe symptomatic AS. AVR was recommended for 823 patients (82%). Of these 823 patients, 721 (87.6%) underwent AVR. We modeled overall survival (OS) since AVR recommendation or intervention date using Cox and multistate models. Results Overall, the median (first, third quartiles) waiting time until operation was 2.9 (1.3, 5.1) weeks. Mortality at these times was lower ( p < 0.001) in the AVR group (1.2%, 0.3%, 1.7%, respectively) than in the group that did not receive AVR (6.9%, 2.9%, 9.8%, respectively). Thirty-day mortality after AVR was 3.9% (3.2% surgical AVR [SAVR] and 7.0% transcatheter AVR [TAVR]). In patients receiving AVR, waiting time was not associated with increased mortality. Mortality while waiting for AVR was 3.7% and 11.6% at 1 and 6 months, respectively. Mortality while waiting for TAVR was higher than that for SAVR (1-, 6-, and 12-month mortality of 3.7%, 8.0%, and 9.6%, respectively, in SAVR group and 3.8%, 23.3%, and 27.5%, respectively, in TAVR group; p < 0.001). Conclusions Some patients do not receive AVR in a timely fashion, and prolonged waiting time for AVR is associated with mortality greater than the AVR operative mortality. Although waiting time was not associated with poor operative outcomes after AVR, many patients may die while waiting for AVR. Patients should receive AVR on a semiurgent, not elective, basis.