What factors are associated with the decision to deny surgery in elderly patients with severe, symptomatic aortic stenosis?
In elderly patients with severe symptomatic aortic stenosis, surgery is frequently denied (33%), primarily driven by older age and LV dysfunction rather than overall comorbidity burden.
AIMS: To analyse decision-making in elderly patients with severe, symptomatic aortic stenosis (AS). METHODS AND RESULTS: In the Euro Heart Survey on valvular heart disease, 216 patients aged > or =75 had severe AS (valve area or =50 mmHg) and angina or New York Heart Association class III or IV. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 72 patients (33%). In multivariable analysis, left ventricular (LV) ejection fraction OR = 2.27, 95% CI (1.32-3.97) for ejection fraction 30-50, OR = 5.15, 95% CI (1.73-15.35) for ejection fraction 50%, P = 0.003 and age OR = 1.84, 95% CI (1.18-2.89) for 80-85 years, OR=3.38, 95% CI (1.38-8.27) for > or =85 vs. 75-80 years, P = 0.008 were significantly associated with the decision not to operate; however, the Charlson comorbidity index was not OR = 1.72, 95% CI (0.83-3.50), P = 0.14 for index > or =2 vs. <2. Neurological dysfunction was the only comorbidity significantly linked with the decision not to operate. CONCLUSION: Surgery was denied in 33% of elderly patients with severe, symptomatic AS. Older age and LV dysfunction were the most striking characteristics of patients who were denied surgery, whereas comorbidity played a less important role.
Iung et al. (Thu,) studied this question.