Document Detail


Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement.
MedLine Citation:
PMID:  19464460     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient population remains ill-defined, many of these patients are now being referred for percutaneous aortic valve replacement. We sought to define the characteristics and outcomes of patients referred for percutaneous aortic valve replacement.
METHODS: Between February 2006 and March 2007, 92 patients were screened for percutaneous aortic valve replacement. Clinical and echocardiographic characteristics of patients undergoing surgical aortic valve replacement, percutaneous aortic valve replacement, balloon aortic valvuloplasty, or no intervention were compared. The primary end point was all-cause mortality.
RESULTS: Nineteen patients underwent successful surgical aortic valve replacement, 18 patients underwent percutaneous aortic valve replacement, and 36 patients had no intervention. Thirty patients underwent balloon aortic valvuloplasty, and of these, 8 patients were bridged to percutaneous aortic valve replacement and 3 were bridged to surgical aortic valve replacement. Of the remaining 19 patients undergoing balloon aortic valvuloplasty, bridging to percutaneous aortic valve replacement could not be accomplished because of death (n = 9 [47%)], exclusion from the percutaneous aortic valve replacement protocol (n = 6 [32%]), and some patients improved after balloon aortic valvuloplasty and declined percutaneous aortic valve replacement (n = 4 [21%]). The most common reasons for no intervention included death while awaiting definitive treatment (n = 10 [28%]), patient uninterested in percutaneous aortic valve replacement (n = 10 [28%]), and questionable severity of symptoms or aortic stenosis (n = 9 [25%]). Patients not undergoing aortic valve replacement had higher mortality compared with those undergoing aortic valve replacement (44% vs 14%) over a mean duration of 220 days.
CONCLUSION: Symptomatic patients with severe aortic stenosis have high mortality if timely aortic valve replacement is not feasible. Twenty percent of the patients referred for percutaneous aortic valve replacement underwent surgical aortic valve replacement with good outcome. Patients undergoing balloon aortic valvuloplasty alone or no intervention had unfavorable outcomes.
Authors:
Samir R Kapadia; Sachin S Goel; Lars Svensson; Eric Roselli; Robert M Savage; Lee Wallace; Srikanth Sola; Paul Schoenhagen; Mehdi H Shishehbor; Ryan Christofferson; Carmel Halley; L Leonardo Rodriguez; William Stewart; Vidyasagar Kalahasti; E Murat Tuzcu
Publication Detail:
Type:  Journal Article     Date:  2009-03-25
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  137     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-09     Revised Date:  2013-02-21    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1430-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / surgery*
Aortic Valve Stenosis / mortality,  physiopathology,  surgery*
Cardiac Catheterization
Catheterization
Female
Heart Valve Prosthesis Implantation* / methods
Hospital Mortality
Humans
Length of Stay
Male
Postoperative Complications
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
KL2 RR024990/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2009 Jun;137(6):1315-6   [PMID:  19464439 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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