Abstract 14323: Clinical Outcomes in Nonsurgically Managed Patients With Very Severe versus Severe Aortic Stenosis
Background: Severe AS is often nonsurgically managed because of severe comorbidities as well as patients' refusal, despite the dismal prognosis under medical management. Recently it has been reported that very severe AS had significantly poor clinical outcomes with conventional treatment even if they were asymptomatic. However, there are only limited data about the outcomes of symptomatic versus asymptomatic and severe versus very severe AS, when the patients are nonsurgically managed.
Methods: Background characteristics and clinical outcomes were retrospectively reviewed for 233 patients (age: 71±11 years) with more than severe AS in whom nonsurgical management was primarily planned. There were 91 patients with very severe AS, defined as the aortic valve area <0.75 cm2 or a peak aortic jet velocity >4.5m/sec (Group A); and 142 patients with severe AS who did not meet the above criteria and the aortic valve area <1.0cm2 or a peak aortic velocity >4.0m/sec (Group B). Clinical outcomes were compared between the two groups, considering the existence of symptom.
Results: Mean follow-up period was 4.6 years. Twenty-nine patients in group A and 62 in group B were asymptomatic. There were no significant difference between the groups in regard to age, gender, and left ventricular ejection fraction. Group A had higher incidence of major adverse cardiac events than group B defined by a composite of death from any cause, aortic valve surgery and admission due to heart failure at 1, 3 and 5 years (A vs B; 50% vs 27%, 71% vs 41%, 82% vs 51%: P<0.001, respectively). The outcome of asymptomatic very severe AS was comparable with symptomatic severe AS, and was significantly worse than asymptomatic severe AS (Figure).
Conclusions:Surgery should be aggressively indicated in patients with very severe AS regardless of symptoms, with particular attention to their extremely worse outcomes relative to severe AS.
- © 2010 by American Heart Association, Inc.