Document Detail


Early surgery versus conventional treatment in asymptomatic very severe aortic stenosis.
MedLine Citation:
PMID:  20308614     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal timing of surgical intervention remains controversial in asymptomatic patients with very severe aortic stenosis. We therefore compared the long-term results of early surgery and a conventional treatment strategy.
METHODS AND RESULTS: From 1996 to 2006, we prospectively included a total of 197 consecutive asymptomatic patients (99 men; age, 63+/-12 years) with very severe aortic stenosis. Patients were excluded if they had angina, syncope, exertional dyspnea, ejection fraction <0.50, significant mitral valve disease, or age >85 years. Very severe aortic stenosis was defined as a critical stenosis in the aortic valve area < or =0.75 cm(2) accompanied by a peak aortic jet velocity > or =4.5 m/s or a mean transaortic pressure gradient > or =50 mm Hg on Doppler echocardiography. The primary end point was defined as the composite of operative mortality and cardiac death during follow-up. Early surgery was performed on 102 patients, and a conventional treatment strategy was used for 95 patients. There were no significant differences between the 2 groups in terms of age, gender, European System for Cardiac Operative Risk Evaluation score, or ejection fraction. During a median follow-up of 1501 days, the operated group had no operative mortalities, no cardiac deaths, and 3 noncardiac deaths; the conventional treatment group had 18 cardiac and 10 noncardiac deaths. The estimated actuarial 6-year cardiac and all-cause mortality rates were 0% and 2+/-1% in the operated group and 24+/-5% and 32+/-6% in the conventional treatment group, respectively (P<0.001), and for 57 propensity score-matched pairs, the risk of all-cause mortality was significantly lower in the operated group than in the conventional treatment group (hazard ratio, 0.135; 95% confidence interval, 0.030 to 0.597; P=0.008).
CONCLUSIONS: Compared with the conventional treatment strategy, early surgery in patients with very severe aortic stenosis is associated with an improved long-term survival by decreasing cardiac mortality. Early surgery is therefore a therapeutic option to further improve clinical outcomes in asymptomatic patients with very severe aortic stenosis and low operative risk.
Authors:
Duk-Hyun Kang; Sung-Ji Park; Ji Hye Rim; Sung-Cheol Yun; Dae-Hee Kim; Jong-Min Song; Suk Jung Choo; Seung Woo Park; Jae-Kwan Song; Jae-Won Lee; Pyo-Won Park
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-03-22
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-06     Completed Date:  2010-04-23     Revised Date:  2011-01-06    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1502-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, Cardiology, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-ku, Seoul, Korea 138-736. dhkang@amc.seoul.kr
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / mortality,  surgery*,  therapy*,  ultrasonography
Death, Sudden, Cardiac / epidemiology,  prevention & control*
Disease-Free Survival
Echocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
Severity of Illness Index*
Time Factors
Comments/Corrections
Comment In:
Circulation. 2010 Dec 21;122(25):e638; author reply e639   [PMID:  21173359 ]

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


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