Long-term outcome of elderly patients with severe aortic stenosis as a function of treatment modality

Pilgrim, Thomas; Englberger, Lars; Rothenbühler, Martina; Stortecky, Stefan; Ceylan, Osman; O'Sullivan, Crochan John; Huber, Christoph; Praz, Fabien; Büllesfeld, Lutz; Langhammer, Bettina; Meier, Bernhard; Jüni, Peter; Carrel, Thierry; Windecker, Stephan; Wenaweser, Peter Martin (2015). Long-term outcome of elderly patients with severe aortic stenosis as a function of treatment modality. Heart (British Cardiac Society), 101(1), pp. 30-36. BMJ Publishing Group 10.1136/heartjnl-2014-306106

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OBJECTIVE

To assess long-term clinical outcomes of consecutive high-risk patients with severe aortic stenosis according to treatment allocation to transcatheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical treatment (MT).

METHODS

Patients with severe aortic stenosis were consecutively enrolled into a prospective single centre registry.

RESULTS

Among 442 patients (median age 83 years, median STS-score 4.7) allocated to MT (n=78), SAVR (n=107), or TAVI (n=257) all-cause mortality amounted to 81%, 37% and 43% after a median duration of follow-up of 3.9 years (p<0.001). Rates of major adverse cerebro-cardiovascular events were lower in patients undergoing SAVR or TAVI as compared with MT (SAVR vs MT: HR 0.31, 95% CI 0.21 to 0.46) (TAVI vs MT: HR 0.34, 95% CI 0.25 to 0.46), with no significant difference between SAVR and TAVI (HR 0.88, 95% CI 0.62 to 1.25). Whereas SAVR (HR 0.39, 95% CI 0.24 to 0.61), TAVI (HR 0.37, 95% CI 0.26 to 0.52), and female gender (HR 0.72, 95% CI 0.53 to 0.99) were associated with improved survival, body mass index ≤20 kg/m(2) (HR 1.60, 95% CI 1.04 to 2.47), diabetes (HR 1.48, 95% CI 1.03 to 2.12), peripheral vascular disease (HR 2.01, 95% CI 1.44 to 2.81), atrial fibrillation (HR 1.74, 95% CI 1.28 to 2.37) and pulmonary hypertension (HR 1.43, 95% CI 1.03 to 2.00) were identified as independent predictors of mortality.

CONCLUSIONS

Among high-risk patients with severe aortic stenosis, long-term clinical outcome through 5 years was comparable between patients allocated to SAVR or TAVI. In contrast, patients with MT had a dismal prognosis.

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