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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)

2016; Elsevier BV; Volume: 118; Issue: 2 Linguagem: Inglês

10.1016/j.amjcard.2016.04.044

1879-1913

Hugo González‐Saldívar, Carlos Pascual, Gonzalo de la Morena, Covadonga Fernández‐Golfín, Carmen Amorós, Mario Baquero Alonso, Luis Martínez‐Dolz, Albert Ariza‐Solé, Gabriela Guzmán, Juan José Gómez‐Doblas, Antonio Jiménez, María Eugenia Fuentes, Laura Galián-Gay, Martín Ruiz Ortiz, Pablo Avanzas, Emad Abu‐Assi, Tomás Ripoll‐Vera, Óscar Dı́az-Castro, Eduardo Pozo, Manuel Martínez‐Sellés, Hugo González Saldívar, Carlos Pascual, T. Parajes-Vázquez, Marina Montero-Magan, Gonzalo de la Morena, Pedro J. Flores‐Blanco, Covadonga Fernández-Golfín, Cristina Bravo Lozano, Leonardo Mejia Rincon, Carmen Amorós, Xavier Borrás, Mario Baquero Alonso, Eva García Camacho, Andrés Sànchez Pérez, Luis Martínez‐Dolz, Herminio Morillas Climent, Jorge Sanz Sánchez, María Ferré Vallverdú, Albert Ariza‐Solé, Gabriela Guzmán, Óscar González Fernández, Juan José Gómez‐Doblas, Antonio Jiménez, Maria Jesús Garcia Sánchez, Pedro L. Sánchez, María Eugenia Fuentes, María Victoria Millán, Laura Galián-Gay, Martín Ruiz Ortiz, Pablo Avanzas, Isaac Pascual, César Morı́s, Emad Abu‐Assi, Tomás Ripoll‐Vera, Yolanda Gómez Pérez, Óscar Dı́az-Castro, Luis Jesús Jiménez‐Borreguero, Eduardo Pozo, Paula Antuña, Dafne Viliani, María Victoria Mogollón Jiménez, Gonzalo Marcos Gómez, Marcelino Cortés, Miguel Orejas, Juan Quiles, Clara Gunturiz, Javier Castrodeza, Javier Tobar, Javier López, Martin Jesús Garcia Gonzalez, Eva Bernal Labrador, J. López Ayerbe, Sonia María Barros, Antoni Carol Ruiz, Javier Botas, Alberto Núñez García, E. Sanz, Alfredo Bardajı́, Cesar S. Caro Martinez, Alicia Gómez Agüera, Teresa Pareja Sierra, Fiorella Quinte Yarcuri, Irene Mateo Rodriguez, María del Pilar Zuazola Martínez, Teresa Pérez, Vicente Ignacio Arrarte Esteban, Francisco Sogorb Garri, Miguel A. Ramírez-Marrero, Sonia Ibars Campaña, Ferrán Padilla Marchan, Jorge Rodríguez‐Capitán, Ramón Andion, Leopoldo Pérez de Isla, P Mahia, José Plaza Carrera, Bernardo García de la Villa Redondo, Félix Valencia-Serrano, Daniel Bravo Bustos, Isaac Lacambra, Guillermo Isasti, Alicia Bautista Pavés, Eduardo Pereyra, Eva Pueo, Luis Cornide Santos, Ana Garrido Martín, Clara Bonanad Lozano, Javier López, Javier Castrodeza Calvo, Javier Tobar Ruiz, Manuel Martínez‐Sellés,

Cardiac Structural Anomalies and Repair

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. 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.