Refusing aortic valve replacement in elderly patients (≥80 years) fit for surgery significantly increased the risk of all-cause mortality compared to undergoing the procedure (HR 12.61, P=0.001).
Cohort (n=103)
Does aortic valve replacement reduce all-cause mortality in patients aged 80 and over with symptomatic, severe aortic stenosis?
In elderly patients (≥80 years) with severe symptomatic aortic stenosis who are fit for surgery, refusing aortic valve replacement is associated with a >12-fold increase in mortality risk.
Effect estimate: HR 12.61
Absolute Event Rate: 11.8% vs 74%
p-value: p=0.001
BACKGROUND: Aortic valve replacement (AVR) can be performed safely in selected elderly patients with aortic stenosis (AS). However, the survival benefits of AVR over conservative treatment have not been convincingly demonstrated in AS patients aged above 80. AIM: To investigate the outcomes of patients aged 80 and over with symptomatic, severe AS and by analyzing the effects of patient's choice in either agreeing or refusing to undergo AVR, determine the survival benefits afforded by AVR. DESIGN: Cohort study. METHODS: Subjects aged 80 and over with severe symptomatic AS, diagnosed between 2001 and 2006 were segregated into three groups: subjects who underwent AVR (Group A); patients who were fit for AVR but declined surgery due to personal choice (Group B) and those who were not fit for surgery and were managed conservatively (Group C). Follow-up was conducted by out-patient attendances, review of medical records and telephone interviews. The primary endpoint was all-cause mortality. RESULTS: A total of 103 patients (86.0 +/- 4.2 years, 41% male) were identified and no patient was lost during follow-up. In Group A (n = 17), all 15 patients who underwent AVR were alive after 3.6 +/- 1.4 years follow-up and 2 died whilst awaiting AVR. Seventy-four percent of Group B (n = 24) and 76% of Group C (n = 62) died during follow-up. Group A had significantly better survival than B and C. (P 12-fold increase in mortality risk. These findings have significant implications for informed decision-making when managing the fit, elderly patient with AS.
Kojodjojo et al. (Tue,) conducted a cohort in Symptomatic, severe aortic stenosis (n=103). Aortic valve replacement (AVR) vs. Refusal of surgery (conservative management) was evaluated on All-cause mortality (HR 12.61, p=0.001). Refusing aortic valve replacement in elderly patients (≥80 years) fit for surgery significantly increased the risk of all-cause mortality compared to undergoing the procedure (HR 12.61, P=0.001).