title: Current decision making and short-term outcome in patients with degenerative aortic stenosis: the Pooled-RotterdAm-Milano-Toulouse In Collaboration Aortic Stenosis survey.
abstract: OBJECTIVE
  The aim of this study was to provide a real-world snapshot of contemporary Heart Team decision making on patients with aortic stenosis (AS) and the consequent short-term clinical outcome.
  
  
  RESULTS
  This was an international multicentre prospective registry encompassing 390 patients with symptomatic severe AS who were prospectively enrolled. Clinical endpoints and the decisive arguments to opt for surgical or transcatheter aortic valve replacement, or medical therapy were recorded separately. The mean age was 76.4±11.6 years, 55% were male and the STS score was 2.9% (IQR 1.6-6.9). The local Heart Teams considered 43%, 25% and 23% to be at low, intermediate and high operative risk with a calculated STS score of 2.18±1.72, 5.08±2.76 and 13.15±9.43, respectively. Overall, 7% were deemed inoperable. Ninety-four percent of patients at low operative risk were sent for SAVR whereas 64% and 92% of intermediate and high-risk patients underwent TAVI. Only 6% of patients did not receive any kind of aortic valve replacement. Overall, 30-day all-cause mortality was 2.8%. TAVI was associated with more major vascular complications, need for permanent pacemakers and post-procedural aortic regurgitation. SAVR had more life-threatening bleedings and new-onset atrial fibrillation.
  
  
  CONCLUSIONS
  The PRAGMATIC AS survey offers a snapshot of the contemporary management of patients with symptomatic severe AS. Multidisciplinary Heart Teams select an optimal strategy based on age, frailty and comorbidities. Nearly half of all patients are sent for TAVI. Only a small minority of patients will not receive valve replacement therapy.
authors: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Nicolas M
authors: NM
authors: Van Mieghem
authors: Nicolas
authors: N
authors: Dumonteil
authors: Alaide
authors: A
authors: Chieffo
authors: Yann
authors: Y
authors: Roux
authors: Robert M A
authors: RM
authors: van der Boon
authors: Gennaro
authors: G
authors: Giustino
authors: Eline
authors: E
authors: Hartman
authors: Yaar
authors: Y
authors: Aga
authors: Louis
authors: L
authors: de Jong
authors: Moussa
authors: M
authors: Abi Ghanem
authors: Bertrand
authors: B
authors: Marcheix
authors: Caterina
authors: C
authors: Cavazza
authors: Didier
authors: D
authors: Carrié
authors: Antonio
authors: A
authors: Colombo
authors: Arie-Pieter
authors: AP
authors: Kappetein
authors: Peter P T
authors: PP
authors: de Jaegere
authors: Didier
authors: D
authors: Tchetche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome