title: Treatment assignment of high-risk symptomatic severe aortic stenosis patients referred for transcatheter AorticValve implantation.
abstract: Transcatheter aortic valve implantation (TAVI) has become an option for patients with symptomatic severe aortic stenosis whose co-morbidities place them at high surgical risk. However, little is known regarding treatment allocation. From May 2008 to May 2011, all high-risk patients with symptomatic severe aortic stenosis referred to an experienced single-center TAVI clinic were reviewed. A total of 170 consecutive patients were evaluated. Of these, 58 (34%) were accepted for TAVI (mean age 81 ± 8 years). Thirty-three patients (19%) were accepted for conventional aortic valve replacement (AVR; mean age 83 ± 6 years). Sixty-two patients (37%) were treated conservatively (mean age 83 ± 6 years). Seventeen patients (10%) died awaiting complete assessment. At 30 days, all-cause mortality was 10% in the TAVI group, 3% in the conventional AVR group, and 32% in the conservatively treated group. Multivariate-adjustment identified the absence of chronic obstructive pulmonary disease (hazard ratio 0.30, 95% confidence interval 0.09 to 0.98, p <0.05) and the absence of frailty (hazard ratio 0.19, 95% confidence interval 0.07 to 0.55, p <0.01) as independent predictors of conventional AVR. In conclusion, of the high-risk patients with severe aortic stenosis referred for TAVI at a large single center, approximately 1/2 were accepted for intervention (conventional AVR or TAVI), and roughly 1/3 were treated conservatively.
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. kbainey@ualberta.ca
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Bainey
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.forename: Mathew
authors.initials: M
authors.lastname: Mercuri
authors.forename: Tony
authors.initials: T
authors.lastname: Lai
authors.forename: Kevin
authors.initials: K
authors.lastname: Teoh
authors.forename: Victor
authors.initials: V
authors.lastname: Chu
authors.forename: Richard P
authors.initials: RP
authors.lastname: Whitlock
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome