title: Comparison of 1-Year Outcome in Patients With Severe Aorta Stenosis Treated Conservatively or by Aortic Valve Replacement or by Percutaneous Transcatheter Aortic Valve Implantation (Data from a Multicenter Spanish Registry).
abstract: The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.
authors.affiliation: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Hugo
authors.initials: H
authors.lastname: González-Saldivar
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Pascual
authors.affiliation: Unidad de Imagen, Servicio de Cardiología, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: de la Morena
authors.affiliation: Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfín
authors.affiliation: Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Amorós
authors.affiliation: Complejo Hospitalario de Toledo, Toledo, Spain.
authors.forename: Mario Baquero
authors.initials: MB
authors.lastname: Alonso
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Luis Martínez
authors.initials: LM
authors.lastname: Dolz
authors.affiliation: Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: Albert Ariza
authors.initials: AA
authors.lastname: Solé
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, IdIPaz, Madrid, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Guzmán-Martínez
authors.affiliation: Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gómez-Doblas
authors.affiliation: Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Antonio Arribas
authors.initials: AA
authors.lastname: Jiménez
authors.affiliation: Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Fuentes
authors.affiliation: Hospital Universitari Vall d Hebron, Barcelona, Spain.
authors.forename: Laura Galian
authors.initials: LG
authors.lastname: Gay
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Martin Ruiz
authors.initials: MR
authors.lastname: Ortiz
authors.affiliation: Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Avanzas
authors.affiliation: Hospital Clínico Universitario de Santiago de Compostela, Spain.
authors.forename: Emad
authors.initials: E
authors.lastname: Abu-Assi
authors.affiliation: Hospital Son Llatzer, Idispa, Palma de Mallorca, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Ripoll-Vera
authors.affiliation: Hospital de Pontevedra, Vigo, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Díaz-Castro
authors.affiliation: Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Eduardo P
authors.initials: EP
authors.lastname: Osinalde
authors.affiliation: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea and Universidad Complutense, Madrid, Spain. Electronic address: mmselles@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Sellés
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D058070:Asymptomatic Diseases; D000066491:Clinical Decision-Making; D015897:Comorbidity; D000072700:Conservative Treatment; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D013030:Spain; D013318:Stroke Volume; D015996:Survival Rate; D062606:Tertiary Care Centers; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome