Introduction:
Although severe symptomatic aortic stenosis (AS) is associated with poor long-term outcome without aortic valve replacement (AVR), many patients are considered high risk for AVR surgery. These patients are typically not referred to cardiac surgery and therefore remain ill defined. Many of these patients are now referred for possible percutaneous AVR (percAVR). We report the clinical and echocardiographic characteristics of these patients with their outcome.
Methods:
All patients screened for percAVR between 2/06 to 3/07 were studied. Clinical and echocardiographic characteristics of patients undergoing surgical AVR (sAVR), percAVR, balloon aortic valvuloplasty (BAV) and medical management were compared. Clinical follow-up was performed for all cause mortality. Patients that were bridged to sAVR or percAVR after BAV were included in the respective groups.
Results:
We screened 92 pts for consideration of percAVR at our institution in 1 year. Of these, 19 pts underwent surgical AVR, 18 patients percAVR and 36 patients had medical management without BAV. BAV was performed in 30 patients of which 8 pts underwent percAVR and 3 had sAVR. Most common reasons for medical management included death while being screened (n=10, 28%), patient not interested in the study (n=10, 28%) and questionable severity of symptoms or AS (n=9, 25%). BAV was used in patients that could not wait for percAVR to become available with an intention to bridge. This could not be accomplished in 9 (45%) pts due to death while waiting for percAVR, 4 (20%) pts doing well after BAV not wanting percAVR, and the remaining 6 (30%) pts with exclusion from the current percAVR protocol (e.g. age, bleeding, infection, etc).
Conclusion:
Symptomatic patients with severe AS have high mortality if AVR is not feasible in a timely manner. About one fifth of the patients referred for percAVR could undergo sAVR with good outcome. Patients managed medically or with BAV alone have unfavorable outcomes.
Characteristics and Outcome of Screened Patients
Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics
