Abstract 3682: Natural History of Very Severe Aortic Stenosis
Background: In patients with severe aortic stenosis (AS), rapid valve replacement surgery is generally indicated after symptom onset. However, selected asymptomatic patients with severe AS may benefit from early elective surgery. Among these patients are those with calcified valves and rapid hemodynamic progression, which is related to stenosis severity. The aim of the present study was to assess the clinical outcome of very severe AS (which is currently not differentiated in the group of pts with severe AS) and to define the natural history of these patients.
Methods: 116 consecutive patients (57 female, age 67±16 yrs) with asymptomatic very severe aortic stenosis defined by a peak aortic jet velocity (AV-Vel) >5.0 m/s (average peak aortic jet velocity 5.37±0.34 m/s, mean gradient 74±11 mmHg, valve area 0.59±0.13 cm2) were included and followed at regular intervals. Patients with other significant valve lesions or concomitant aortic regurgitation were excluded. Outcome was assessed and event-free survival with events defined as indication for aortic valve replacement according to current guidelines or death was determined. All but 11 of the patients in this group had moderately-to-severely calcified aortic valves.
Results: Median potential follow-up was 41 months (interquartile range 26 to 63 months), 90 patients developed symptoms warranting aortic valve replacement and 6 cardiac deaths were observed. Patients with an AV-Vel between 5.0 and 5.5 m/s had event-free survival rates after 1, 2, 3 and 4 years of 78%, 47%, 31%, and 19% respectively. Event-free survival was significantly worse for patients with an AV-Vel >5.5 m/s with respective event-free survival rates of 45%, 29%, 17%, and 6% (p<0.0001). There were 5 cardiac deaths in previously asymptomatic patients (congestive heart failure 5, myocardial infarction 1) and 1 sudden death. In this high-risk group of patients, aortic valve area, coronary artery disease, hypertension, diabetes and hypercholesterolemia were not associated with higher event-rates.
Conclusion: In asymptomatic patients with AS, very high aortic jet velocities characterize patients with a poor prognosis. Early elective valve replacement surgery should thus be considered in patients with very severe aortic stenosis.