Medical or balloon valvuloplasty management of severe aortic stenosis in TAVI-ineligible patients was associated with 37.2% mortality, compared to 21.5% with surgical management.
Cohort (n=362)
What are the incidences, causes, and correlates of mortality in patients with severe symptomatic aortic stenosis ineligible for TAVI trials?
Patients with severe symptomatic aortic stenosis ineligible for TAVI trials face extremely high mortality rates, especially when managed non-surgically.
Absolute Event Rate: 37.2% vs 21.5%
BACKGROUND: Transcatheter aortic valve implantation is currently being evaluated in patients with severe aortic stenosis who are considered high-risk surgical candidates. This study aimed to detect incidences, causes, and correlates of mortality in patients ineligible to participate in transcatheter aortic valve implantation studies. METHODS AND RESULTS: From April 2007 to July 2009, a cohort of 362 patients with severe aortic stenosis were screened and did not meet the inclusion/exclusion criteria necessary to participate in a transcatheter aortic valve implantation trial. These patients were classified into 2 groups: group 1 (medical): 274 (75.7%): 97 (35.4%) treated medically and 177 (64.6%) treated with balloon aortic valvuloplasty; and group 2 (surgical): 88 (24.3%). The medical/balloon aortic valvuloplasty group had significantly higher clinical risk compared with the surgical group, with significantly higher Society of Thoracic Surgeons score (12.8±7.0 versus 8.5±5.1; P<0.001) and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (42.4±22.8 versus 24.4±18.1; P<0.001). The medical/balloon aortic valvuloplasty group had a higher New York Heart Association functional class, incidence of renal failure, and lower ejection fraction. During median follow-up of 377.5 days, mortality in the medical/balloon aortic valvuloplasty group was 102 (37.2%), and during median follow-up of 386 days, mortality in the surgical group was 19 (21.5%). Multivariable adjustment analysis identified renal failure (hazard ratio HR: 5.60), New York Heart Association class IV (HR: 5.88), and aortic systolic pressure (HR: 0.99) as independent correlates for mortality in the medical group, whereas renal failure (HR: 7.45), Society of Thoracic Surgeons score (STS; HR: 1.09) and logistic EuroSCORE (HR: 1.45) were correlates of mortality in the in the surgical group. CONCLUSIONS: Patients with severe symptomatic aortic stenosis not included in transcatheter aortic valve implantation trials do poorly and have extremely high mortality rates, especially in nonsurgical groups, and loss of quality of life in surgical groups.
Ben‐Dor et al. (Mon,) conducted a cohort in severe symptomatic aortic stenosis (n=362). Medical therapy or balloon aortic valvuloplasty vs. Surgical therapy was evaluated on mortality. Medical or balloon valvuloplasty management of severe aortic stenosis in TAVI-ineligible patients was associated with 37.2% mortality, compared to 21.5% with surgical management.