title: Characteristics of inoperable patients with severe aortic valve stenosis -in the era of transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic option for severe aortic valvular stenosis (AS). To determine the indication for TAVR, it is mandatory to clarify the characteristics of the patients who were judged as inoperable for conventional aortic valve replacement (cAVR).
  
  
  METHODS
  Of 185 patients newly diagnosed as severe AS from March 2010 to April 2011, we studied the characteristics of 61 (33%) patients (mean age, 86 ± 8 years) who were judged as inoperable.
  
  
  RESULTS
  Younger patients (<85 years old, n = 22) had more major comorbidities and lower left ventricular ejection fraction than older patients (≥85 years old, n = 39). Mean estimated mortality for cAVR by Japan score was 7.0% ± 7.4%. Japan score did not correlate to age and was calculated relatively low in the older age group (6.2% ± 7.0%) than the younger age group (8.3% ± 8.1%).
  
  
  CONCLUSIONS
  One thirds of severe AS patients were judged as inoperable. In advanced age patients, age itself and other factors, which are not included in the conventional scoring systems, might have contributed to the decision making not to perform cAVR by cardiologists. Further study is necessary to define risk factors except for age.
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors: Tatsuya
authors: T
authors: Seki
authors: Mamoru
authors: M
authors: Sakakibara
authors: Yasushige
authors: Y
authors: Shingu
authors: Hiroki
authors: H
authors: Katoh
authors: Satoru
authors: S
authors: Wakasa
authors: Hiroyuki
authors: H
authors: Tsutsui
authors: Yoshiro
authors: Y
authors: Matsui
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D016330:Frail Elderly; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007564:Japan; D008297:Male; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome