Abstract 19599: Survival in High Risk Patients with Severe Aortic Stenosis: Intervention versus Surgery versus Medical Therapy
Objective Among high surgical risk patients with severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI), we aimed to analyse the survival outcomes based on the final treatment allocation (specifically, TAVI, surgical aortic valve replacement (AVR), or medical therapy).
Methods: Between 06/2007 and 08/2009 382 high surgical risk patients were referred to our hospital for TAVI. Final treatment allocation was based on clinical judgment that took into account frailty, comorbidities, logistic EuroSCORE and anatomical suitability.
Results: The mean age and mean logistic EuroSCORE were 81±7 years and 23%±15%, respectively. 241/381 patients (63%) were considered suitable for TAVI. Of those, 12 died on the waiting list (median survival time:15 days) and 229 underwent transarterial or transapical TAVI. Among patients who did not undergo TAVI (n=141), 25% refused TAVI, 28% had unsuitable anatomy for TAVI, and 47% were considered too high risk for TAVI. 64/141 patients underwent conventional AVR and 77/141 patients received conservative therapy. Survival at one year was significantly better in patients who underwent TAVI (75%) or AVR (73%) than patients receiving medical therapy only (51%, p<0.001, see figure 1). Medically treated patients had a significantly higher EuroSCORE than TAVI or AVR patients (30%±18% vs 21%±14%, p<0.001)
Conclusions: Within a cohort of high surgical risk patients referred for TAVI, medically treated patients had worse 1-year survival outcomes than TAVI or AVR treated patients. The benefit of TAVI and AVR over medical treatment emerged only at 6-month follow-up. There was no significant survival difference between TAVI and SAVR patients.
- © 2010 by American Heart Association, Inc.