Abstract 3166: Unoperated Patients With Severe Symptomatic Aortic Stenosis
BACKGROUND: Limited data is available for patients with symptomatic severe aortic stenosis (AS) who do not undergo aortic valve replacement (AVR). We examined why symptomatic patients with severe AS did not undergo AVR.
METHODS: We reviewed Aurora St. Luke’s Medical Center’s echocardiography database and identified all adult patients with evidence of severe AS (defined as valve area of <1.0 cm2) documented between January 1, 2006 and December 31, 2008. Medical records were reviewed for demographic and clinical characteristics and diagnostic procedures. If AVR was not performed, records were reviewed to determine the reason. Anticipated operative risk for patients who did not undergo AVR was calculated using the logistic EuroSCORE.
RESULTS: Between January 2006 and December 2008, 448 patients had severe AS on echocardiogram. Of these, 115 patients (26%; median age 74 years) underwent AVR. The 333 unoperated patients included 272 patients (82%) over the age of 75 years (median age 84) and 200 patients (60%) who were symptomatic with AS; 308 (92.5%) had multiple comorbidities; 91 (27%) had undergone previous coronary artery bypass grafting; 132 (40%) had heart failure; 46 (14%) had angina pectoris alone; while 30 (9%) had syncope or presyncope (table⇓). For the unoperated patients, median logistic EuroSCORE (mortality %) was significantly lower among asymptomatic than symptomatic patients (33.1% vs. 67.5%, p<0.001). Among asymptomatic patients, the most common reason for not operating was asymptomatic status (90%), while age alone (43%), age and multiple comorbid conditions (50%), and patient refusal (4%) were also cited as reasons for not operating. In another 3%, no reason was cited at all. At a median follow-up of 13 months, only 174 of the 333 (52%) unoperated patients were alive.
CONCLUSION: Surgery was denied in 60% of patients with severe, symptomatic AS. Older age and multiple comorbidities were the most often cited characteristics of patients denied surgery.