title: Mortality while waiting for aortic valve replacement.
abstract: BACKGROUND
  Severe symptomatic aortic stenosis (AS) is associated with high mortality without intervention. The impact of waiting time for aortic valve replacement (AVR), either surgically or transcatheter, has not been reported.
  
  
  METHODS
  From January 2008 to December 2012, we identified 1,005 patients with severe symptomatic AS. AVR was recommended for 823 patients (82%). Of these 823 patients, 721 (87.6%) underwent AVR. We modeled overall survival (OS) since AVR recommendation or intervention date using Cox and multistate models.
  
  
  RESULTS
  Overall, the median (first, third quartiles) waiting time until operation was 2.9 (1.3, 5.1) weeks. Mortality at these times was lower (p<0.001) in the AVR group (1.2%, 0.3%, 1.7%, respectively) than in the group that did not receive AVR (6.9%, 2.9%, 9.8%, respectively). Thirty-day mortality after AVR was 3.9% (3.2% surgical AVR [SAVR] and 7.0% transcatheter AVR [TAVR]). In patients receiving AVR, waiting time was not associated with increased mortality. Mortality while waiting for AVR was 3.7% and 11.6% at 1 and 6 months, respectively. Mortality while waiting for TAVR was higher than that for SAVR (1-, 6-, and 12-month mortality of 3.7%, 8.0%, and 9.6%, respectively, in SAVR group and 3.8%, 23.3%, and 27.5%, respectively, in TAVR group; p<0.001).
  
  
  CONCLUSIONS
  Some patients do not receive AVR in a timely fashion, and prolonged waiting time for AVR is associated with mortality greater than the AVR operative mortality. Although waiting time was not associated with poor operative outcomes after AVR, many patients may die while waiting for AVR. Patients should receive AVR on a semiurgent, not elective, basis.
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois. Electronic address: malaisrie@northwestern.edu.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Eileen
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Jane
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Edwin C
authors.initials: EC
authors.lastname: McGee
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Travis O
authors.initials: TO
authors.lastname: Abicht
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Hyde
authors.initials: H
authors.lastname: Russell
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.affiliation: Bluhm Cardiovascular Institute, Division of Cardiac Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*