Abstract 18220: Aortic Valve Replacement is Associated with Increased Survival in Asymptomatic Patients with Severe Aortic Stenosis
Objectives: Aortic valve replacement (AVR) in patients with asymptomatic, severe aortic stenosis (AS) remains controversial. Current guidelines recommend medical management for truly asymptomatic patients with severe AS and normal left ventricular function. This study sought to determine the natural history of patients with asymptomatic, severe AS, stratified to medical and surgical management.
Methods: Patients with severe AS were identified by echocardiography performed in a single tertiary care institution from 2005 to 2009. Severe AS was defined as peak jet velocity >4.0 m/s, mean pressure gradient >40 mmHg, or an aortic valve area <1.0 cm2. Patients with dyspnea, chest pain, or syncope were excluded. Indications for AVR included ejection fraction < 50%, very severe AS, abnormal exercise stress test, concurrent cardiac surgery, and non-cardiac surgery preoperative optimization.
Results: One hundred sixty-one patients were identified, of whom 118 were managed medically and 43 underwent AVR. The medical group was older (75±14 vs 64±11 yrs, p<0.001), had less COPD (p=0.045) and had greater prevalence of mitral regurgitation (MR) 2+ or greater (p<0.001). The unadjusted 1-, 2-, and 3-year survival rates in the surgical group remained at 95.4% compared to 77.6%, 71.1%, and 59.0%, respectively, in the medical group (p<0.001). (Figure 1) By univariate analysis AVR (HR=0.11, 95% CI 0.03–0.45, p=0.003), age (HR=1.92, 95% CI 1.44–2.56 per decade, p<0.001), and MR (HR=2.40, 95% CI 1.26–4.57 p=0.008) were significantly associated with survival. On multivariable analysis, age was associated with mortality (p=0.004) but AVR (HR=0.21, 95% CI 0.05–0.91, p=0.04) remained significantly associated with survival after controlling for age.
Conclusions: Overall survival is worse for asymptomatic patients with severe AS who are managed medically compared to surgical management. Early surgery may be warranted in patients with asymptomatic, severe AS.
- © 2010 by American Heart Association, Inc.