Clinical outcomes of patients with severe aortic stenosis at increased surgical risk according to treatment modality

Wenaweser, Peter; Pilgrim, Thomas; Kadner, Alexander; Huber, Christoph; Stortecky, Stefan; Buellesfeld, Lutz; Khattab, Ahmed A; Meuli, Fabienne; Roth, Nadja; Eberle, Balthasar; Erdös, Gabor; Brinks, Henriette; Kalesan, Bindu; Meier, Bernhard; Jüni, Peter; Carrel, Thierry; Windecker, Stephan (2011). Clinical outcomes of patients with severe aortic stenosis at increased surgical risk according to treatment modality. Journal of the American College of Cardiology, 58(21), pp. 2151-2162. New York, N.Y.: Elsevier 10.1016/j.jacc.2011.05.063

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Objectives The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) compared with medical treatment (MT) and surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) at increased surgical risk. Background Elderly patients with comorbidities are at considerable risk for SAVR. Methods Since July 2007, 442 patients with severe AS (age: 81.7 ± 6.0 years, mean logistic European System for Cardiac Operative Risk Evaluation: 22.3 ± 14.6%) underwent treatment allocation to MT (n = 78), SAVR (n = 107), or TAVI (n = 257) on the basis of a comprehensive evaluation protocol as part of a prospective registry. Results Baseline clinical characteristics were similar among patients allocated to MT and TAVI, whereas patients allocated to SAVR were younger (p < 0.001) and had a lower predicted peri-operative risk (p < 0.001). Unadjusted rates of all-cause mortality at 30 months were lower for SAVR (22.4%) and TAVI (22.6%) compared with MT (61.5%, p < 0.001). Adjusted hazard ratios for death were 0.51 (95% confidence interval: 0.30 to 0.87) for SAVR compared with MT and 0.38 (95% confidence interval: 0.25 to 0.58) for TAVI compared with MT. Medical treatment (<0.001), older age (>80 years, p = 0.01), peripheral vascular disease (<0.001), and atrial fibrillation (p = 0.04) were significantly associated with all-cause mortality at 30 months in the multivariate analysis. At 1 year, more patients undergoing SAVR (92.3%) or TAVI (93.2%) had New York Heart Association functional class I/II as compared with patients with MT (70.8%, p = 0.003). Conclusions Among patients with severe AS with increased surgical risk, SAVR and TAVI improve survival and symptoms compared with MT. Clinical outcomes of TAVI and SAVR seem similar among carefully selected patients with severe symptomatic AS at increased risk.

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 > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Wenaweser, Peter Martin; Pilgrim, Thomas; Kadner, Alexander; Huber, Christoph; Stortecky, Stefan; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Eberle, Balthasar; Erdös, Gabor; Most, Henriette; Kalesan, Bindu; Meier, Bernhard; Jüni, Peter; Carrel, Thierry and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 14:19

Last Modified:

23 Jan 2018 12:16

Publisher DOI:

10.1016/j.jacc.2011.05.063

PubMed ID:

22078420

Web of Science ID:

000296761600002

BORIS DOI:

10.7892/boris.6081

URI:

https://boris.unibe.ch/id/eprint/6081 (FactScience: 210975)

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