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

[img] Text
Pilgrim Heart 2015.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (917kB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Herz- und Gefässchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Herz- und Gefässchirurgie

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Pilgrim, Thomas; Englberger, Lars; Rothenbühler, Martina; Stortecky, Stefan; O'Sullivan, Crochan John; Huber, Christoph; Praz, Fabien; Büllesfeld, Lutz; Langhammer, Bettina; Meier, Bernhard; Jüni, Peter; Carrel, Thierry; Windecker, Stephan and Wenaweser, Peter Martin

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1468-201X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

14 Oct 2014 10:37

Last Modified:

02 Jul 2015 15:17

Publisher DOI:

10.1136/heartjnl-2014-306106

PubMed ID:

25163691

BORIS DOI:

10.7892/boris.58496

URI:

https://boris.unibe.ch/id/eprint/58496

Actions (login required)

Edit item Edit item
Provide Feedback