Abstract 3683: Comparison of Early Surgery versus Conventional Treatment in Asymptomatic Very Severe Aortic Stenosis
Backgrounds: The optimal timing of surgical intervention remains controversial in asymptomatic patients with very severe aortic stenosis (AS), and we tried to compare long-term results of early surgery to conventional treatment strategy based on current guidelines.
Methods: From 1997 to 2005, we prospectively included a total of consecutive 117 patients (56 men, age;60±11 years) with very severe AS, and the exclusion criteria were defined as the presence of angina, syncope, exertional dyspnea, ejection fraction <0.50, significant mitral valve disease and age >85 years. Severity of AS was assessed by Doppler echocardiography, and AS was graded as very severe when aortic valve (AV) area <0.75 cm2. The primary end-point was defined as occurrence of cardiac death during follow-up, and the secondary end-point was death from any cause.
Results: Early surgery was performed on 51 patients (OP group), and conventional strategy was chosen on 66 patients (CONV group). There were no significant differences between the two groups in terms of age, gender, EuroSCORE, ejection fraction, AV area, etiology of AS and degree of AV calcification. During median follow-up of 62 months, there were no cardiac and 2 non-cardiac deaths in OP group, and 10 cardiac and 6 non-cardiac deaths in CONV group. In CONV group, 36 patients underwent late AV replacement during follow-up and the survival rates free of cardiac death or surgery were 70±6% at 2 years, 43±6% at 4 years, and 27±6% at 6 years. The mortality and cardiac mortality rate was significantly lower in OP group than CONV group (p<0.01), and in the propensity score-matched cohort, the 6-year actuarial cardiac mortality rate was significantly lower in OP group than in CONV group (0% vs. 21±8%, p=0.024). Baseline characteristics and follow-up results were summarized in table⇓.
Conclusions: Early surgery can be a therapeutic option to further improve clinical outcomes in asymptomatic patients with very severe AS and low operative risks.