Five-Year Clinical Outcome of Asymptomatic vs. Symptomatic Severe Aortic Stenosis After Aortic Valve Replacement.
There is discordance regarding the effect of symptom status before aortic valve replacement (AVR) on long-term outcome after AVR in severe aortic stenosis (AS).



The CURRENT AS registry is a multicenter retrospective registry enrolling 3,815 consecutive patients with severe AS. Among 1,196 patients managed with the initial AVR strategy, long-term clinical outcomes were compared between the symptomatic patients (n=905), and asymptomatic patients (n=291). Median follow-up interval was 1337 days with a 91% follow-up rate at 2 years. AVR was performed in 886 patients (98%) in the symptomatic group and in 287 patients (99%) in the asymptomatic group. Symptomatic patients were older and more often had comorbidities than asymptomatic patients with similar echocardiographic AS severity. The cumulative 5-year incidences of all-cause death and heart failure (HF) hospitalization were significantly higher in symptomatic patients than in asymptomatic patients (25.6% vs. 15.4%, P=0.001, and 14.2% vs. 3.8%, P<0.001, respectively). On landmark analysis at 30 days after AVR, the differences in mortality and HF hospitalization between the 2 groups were mainly observed beyond 30 days.



When managed with the initial AVR strategy, the long-term outcomes of symptomatic severe AS were worse than those of asymptomatic severe AS. Early AVR strategy might be recommended in some selected asymptomatic severe AS patients with reasonable operative risk.
Department of Cardiology, Kokura Memorial Hospital.
Shinichi
S
Shirai
Tomohiko
T
Taniguchi
Takeshi
T
Morimoto
Kenji
K
Ando
Kengo
K
Korai
Kenji
K
Minakata
Michiya
M
Hanyu
Fumio
F
Yamazaki
Tadaaki
T
Koyama
Tatsuhiko
T
Komiya
Norio
N
Kanamori
Koichiro
K
Murata
Takeshi
T
Kitai
Yuichi
Y
Kawase
Chisato
C
Izumi
Tsukasa
T
Inada
Eri
E
Minamino-Muta
Takao
T
Kato
Moriaki
M
Inoko
Katsuhisa
K
Ishii
Naritatsu
N
Saito
Kazuo
K
Yamanaka
Noboru
N
Nishiwaki
Hiroyuki
H
Nakajima
Toshihiko
T
Saga
Shogo
S
Nakayama
Genichi
G
Sakaguchi
Atsushi
A
Iwakura
Kotaro
K
Shiraga
Koji
K
Ueyama
Keiichi
K
Fujiwara
Senri
S
Miwa
Junichiro
J
Nishizawa
Mitsuru
M
Kitano
Hitoshi
H
Kitayama
Ryuzo
R
Sakata
Takeshi
T
Kimura
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000209:etiology*; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D063189:Symptom Assessment / Q000706:statistics & numerical data*