Document Detail

Correlates and causes of death in patients with severe symptomatic aortic stenosis who are not eligible to participate in a clinical trial of transcatheter aortic valve implantation.
MedLine Citation:
PMID:  20837923     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transcatheter aortic valve implantation is currently being evaluated in patients with severe aortic stenosis who are considered high-risk surgical candidates. This study aimed to detect incidences, causes, and correlates of mortality in patients ineligible to participate in transcatheter aortic valve implantation studies. METHODS AND RESULTS: From April 2007 to July 2009, a cohort of 362 patients with severe aortic stenosis were screened and did not meet the inclusion/exclusion criteria necessary to participate in a transcatheter aortic valve implantation trial. These patients were classified into 2 groups: group 1 (medical): 274 (75.7%): 97 (35.4%) treated medically and 177 (64.6%) treated with balloon aortic valvuloplasty; and group 2 (surgical): 88 (24.3%). The medical/balloon aortic valvuloplasty group had significantly higher clinical risk compared with the surgical group, with significantly higher Society of Thoracic Surgeons score (12.8±7.0 versus 8.5±5.1; P<0.001) and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (42.4±22.8 versus 24.4±18.1; P<0.001). The medical/balloon aortic valvuloplasty group had a higher New York Heart Association functional class, incidence of renal failure, and lower ejection fraction. During median follow-up of 377.5 days, mortality in the medical/balloon aortic valvuloplasty group was 102 (37.2%), and during median follow-up of 386 days, mortality in the surgical group was 19 (21.5%). Multivariable adjustment analysis identified renal failure (hazard ratio [HR]: 5.60), New York Heart Association class IV (HR: 5.88), and aortic systolic pressure (HR: 0.99) as independent correlates for mortality in the medical group, whereas renal failure (HR: 7.45), Society of Thoracic Surgeons score (STS; HR: 1.09) and logistic EuroSCORE (HR: 1.45) were correlates of mortality in the in the surgical group. CONCLUSIONS: Patients with severe symptomatic aortic stenosis not included in transcatheter aortic valve implantation trials do poorly and have extremely high mortality rates, especially in nonsurgical groups, and loss of quality of life in surgical groups.
Itsik Ben-Dor; Augusto D Pichard; Manuel A Gonzalez; Gaby Weissman; Yanlin Li; Steven A Goldstein; Petros Okubagzi; Asmir I Syed; Gabriel Maluenda; Sara D Collins; Cedric Delhaye; Kohei Wakabayashi; Michael A Gaglia; Rebecca Torguson; Zhenyi Xue; Lowell F Satler; William O Suddath; Kenneth M Kent; Joseph Lindsay; Ron Waksman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S37-42     Citation Subset:  AIM; IM    
Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Aged, 80 and over
Aortic Stenosis, Subvalvular* / complications,  mortality,  physiopathology,  surgery
Aortic Valve / surgery*
Blood Pressure
Disease-Free Survival
Follow-Up Studies
Heart Catheterization*
Kidney Failure / etiology,  mortality
Risk Factors
Severity of Illness Index
Survival Rate

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

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