Abstract 3105: Aortic Valve Replacement but not Age Predicts Survival in Elderly Patients with Aortic Stenosis: A 17 Year Follow Up
Background: Aortic Stenosis (AS) is a common cause of morbidity and mortality. This prospective cohort study aimed to: establish outcomes of conservative and surgical management in an elderly population, define a model for prediction of progression and provide a method for optimising selection for aortic valve replacement (AVR).
Methods: Patients with AS were enrolled from 1988 to 1994 and followed until 2005. The composite primary endpoint was time to death or AVR. Secondary endpoints were time to death and echocardiographic progression of AS - aortic valve area (AVA), mean aortic valve gradient (mAVG). The impact of patient comorbidities on survival was assessed via the validated, age adjusted Charlson Index. Data was prospectively collated via medical record review and telephone interviews.
Results: The mean age at enrolment was 74±7 years (n=242). Mean AVA was 1.25cm2 and mAVG was 29.1 mmHg. Follow up duration was 9±4.7 years. Patients undergoing AVR and conservative management had similar Charlson Index scores (p=0.952). The primary endpoint occurred in 188 patients (78%), with 65 patients (27%) undergoing AVR and 146 (60%) patients dying during the study. The mean time to the primary endpoint was 8.63 years (CI 7.9–9.3). AVR was the only independent predictor of longitudinal survival (p=0.002). The Charlson Index but not age at AVR, predicted mortality post AVR (p=0.003, HR 1.35, CI 1.11–1.65). Using a regression model, progression of AVA was -0.07 cm2/year and mAVG= Exp (0.147 x years + 1.66).
Conclusions: Elderly patients receive significant survival advantage from AVR. Comorbidities but not age at AVR determined post-surgical mortality.