Document Detail


Clinical profile and outcome of patients with severe aortic stenosis at high surgical risk: Single center prospective evaluation according to treatment assignment.
MedLine Citation:
PMID:  22915555     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The study sought to assess the clinical profile, outcome and predictors for mortality of "real-world" high-risk severe aortic stenosis patients according to the mode of treatment assigned. METHODS: Patients were referred to a dedicated clinic for meticulous screening and multidisciplinary team assessment and 343 were finally assigned treatment (age 81.3±7.2 years, 42.3% men): TAVR with the Edwards SAPIEN or CoreValve device, 100 (29.2%); SAVR, 61 (17.8%); balloon valvuloplasty (as definitive therapy), 27 (7.9%); medication only, 155 (45.2%). No patient was lost to follow-up. RESULTS: The balloon-valvuloplasty group had a significantly higher 1-month mortality rate (18.5%) than the TAVR group (3%, P=0.006) and medical-therapy group (3.9%; p=0.004), without significant difference from the SAVR group (11.5%, P= 0.5). One-year cumulative survival was significantly higher in the TAVR group (92%) than in the other groups (SAVR 71%, balloon valvuloplasty 61.5%, medication 65%; all P<0.001). Among survivors, 1-year rates of high functional class (NYHA I/II) were as follows: TAVR, 84.6%; SAVR, 63.3%; balloon valvuloplasty, 18.2%; medication, 21.4% (TAVR vs. SAVR, P=0.04; SAVR vs. balloon valvuloplasty or medical therapy, P=0.01). On multivariate regression analysis, renal failure (HR 5.3, P<0.001), not performing TAVR (HR 4.9, P<0.001), and pulmonary pressure (10 mmHg, HR 1.2, P=0.02) were independent predictors of 1-year mortality. CONCLUSIONS: TAVR, performed in carefully selected high-risk patients, is associated with an excellent survival rate and high functional class. Patients treated with another of the available modalities, including SAVR, had a worse outcome, regardless of which alternative treatment they receive. © 2012 Wiley Periodicals, Inc.
Authors:
Danny Dvir; Alexander Sagie; Eyal Porat; Abid Assali; Yaron Shapira; Hana Vaknin-Assa; Gideon Shafir; Tamir Bental; Roman Nevzorov; Alexander Battler; Ran Kornowski
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-23
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Affiliation:
Departments of Cardiology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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