Clinical outcomes in high-risk patients with a severe aortic stenosis: a seven-year follow-up analysis.

Vollenbroich, René; Sakiri, Elmaze; Roost, Eva; Stortecky, Stefan; Rothenbühler, Martina; Räber, Lorenz; Englberger, Lars; Wenaweser, Peter Martin; Carrel, Thierry; Windecker, Stephan; Pilgrim, Thomas (2019). Clinical outcomes in high-risk patients with a severe aortic stenosis: a seven-year follow-up analysis. Swiss medical weekly, 149, w20013. EMH Schweizerischer Ärzteverlag 10.4414/smw.2019.20013

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INTRODUCTION The aim of this study was to assess the clinical outcomes of high-risk patients with severe aortic stenosis (AS) allocated to medical treatment (MT), transcatheter aortic valve replacement (TAVR), and surgical aortic valve replacement (SAVR) through extended follow-up. METHODS AND RESULTS Consecutive patients with severe symptomatic AS included in a prospective single centre registry underwent sweep follow-up between March and August 2016. Clinical outcomes were assessed using a competing risk model. A total of 442 patients (median age 83 years; 52% female) were allocated to MT (n = 78), SAVR (n = 107), or TAVR (n = 257) with a gradient of surgical risk as assessed by logistic EuroSCORE (MT: 27.9 ± 14.5%, TAVR: 24.7 ± 24.9%, SAVR: 12.5 ± 8.2%; p <0.001). Survival after a median duration of follow-up of seven years was 6.4% (MT), 30.4% (TAVR), and 46.7% (SAVR), respectively (p <0.001). One TAVR and one SAVR patient underwent repeat intervention for valvular degeneration between 4.5 and 8.4 years after intervention. Compromised left ventricular function (LVEF <40%) was associated with increased mortality (HR 1.62, 95% CI 1.22–2.15; p <0.0001), whereas female sex was protective (HR 0.68, 95% CI 0.53–0.88; p = 0.0006). CONCLUSION Both TAVR and SAVR reduced mortality compared to MT throughout a median duration of follow-up of seven years. Repeat interventions for valvular degeneration were rare.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Vollenbroich, René; Roost, Eva; Stortecky, Stefan; Rothenbühler, Martina; Räber, Lorenz; Englberger, Lars; Wenaweser, Peter Martin; Carrel, Thierry; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1424-7860

Publisher:

EMH Schweizerischer Ärzteverlag

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

25 Apr 2019 11:31

Last Modified:

23 Oct 2019 00:20

Publisher DOI:

10.4414/smw.2019.20013

PubMed ID:

30957214

BORIS DOI:

10.7892/boris.130309

URI:

https://boris.unibe.ch/id/eprint/130309

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