Abstract 3046: Survival of Patients with Aortic Stenosis Referred for Percutaneous Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative for patients with severe symptomatic aortic stenosis (AS) who are poor candidates for surgical aortic valve replacement. Current TAVR protocols have strict criteria limiting the availability of this technology. To evaluate survival and outcomes of patients with severe AS who were excluded from ongoing European TAVR trials using the Edwards Sapien valve. 141 patients with severe symptomatic AS were referred for possible PAVR to Rouen University Hospital from April 1, 2006 to November 30, 2007. Of these, 38 patients were implanted, 52 are awaiting implantation, and 51 were excluded. Of the excluded patients, 1 was lost to follow up. Patients excluded or waiting for valve implantation were included in the study and were followed until December 31, 2007. Demographic, clinical and hemodynamic variables were assessed. Survival, cause of death, and factors predicting these outcomes were analyzed. One hundred and two patients (48 males and 54 female) were included in our study and were followed for a mean of 6 months. Patients excluded from the TAVR protocol (n=50) had an observed mortality rate of 50%, with a mean time to death of 2 months (8 days - 8 months). Initial logistic EuroSCORE (20.91% vs. 28.83%, p=0.0013) and ejection fraction (44% vs. 51%, p=0.0013) were associated with mortality. Patients waiting for valve implantation (n=52) had a mortality rate of 23%. Mortality was associated with a higher logistic EuroSCORE (31% vs. 23%, p=0.007), lower ejection fraction (43% vs. 51%, p=0.002), and smaller aortic valve area (0.57 vs. 0.67, p=0.05) A logistic EuroSCORE ≥ 23% was associated with greater mortality risk, odds ratio of 5.6, in patients excluded for TAVR. Patients considered for TAVR have a high rate of early mortality without treatment. Risk stratification may help prioritize patients selected for PAVR.