Abstract 2864: Frequency And Predictors Of Nonsurgical Management In Patients With Severe Aortic Stenosis
Background: Data from our center and others have shown that aortic valve replacement (AVR) is not offered to many of the patients with severe aortic stenosis (AS) despite standard indications. We investigated factors leading to the decision not to operate.
Methods: Our echocardiographic database between the years 1993 and 2003 was screened for patients with severe AS (aortic valve area ≤0.8cm2). Of the 740 patients with severe AS, 453 did not undergo AVR. Predictors of nonsurgical management were analyzed.
Results: Compared to those undergoing AVR, medically managed patients were older (76 ± 13 vs.72 ± 12 years, p<0.0001), lower LV ejection fraction (51 ± 21% vs.57 ± 18%, p=0.008) and lower prevalence of coronary artery disease (34% vs. 55%, p<0.0001), diabetes mellitus (14% vs.22%, p=0.004), and hypertension (35% vs.55%, p<0.0001). Using the logistic regression model, older age and chronic renal insufficiency were independent predictors for not performing AVR. Overall non AVR rate was 61% in the whole cohort, compared to 71% in the octogenarians (n=197/277), 88% in nonagenarians (n=37/42), 70% in those with EF ≤35% (n=136/194), 73% in those with mean transaortic gradient of ≤30 mmHg (n=99/135), 70% in those with pulmonary artery systolic pressure ≥60 (83/119), 71% in asymptomatic patients (n=239/338), 53% in symptomatic patients (n=214/402), and 61% in those with aortic valve area ≥0.6 cm2 (n=137/225)
Conclusion: 1) There is high nonsurgical rate in patients with severe AS, even when they are symptomatic. 2) Independent predictors of nonsurgical management included older age and presence of chronic renal insufficiency. 3) High nonsurgical rate is not adequately explained by advanced age or co -morbidities.