| Severe aortic stenosis in a veteran population: treatment considerations and survival. | |
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MedLine Citation:
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PMID: 20103320 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We examined factors affecting the choice of surgical versus medical treatment of severe aortic stenosis and evaluated associated patient survival. METHODS: We retrospectively reviewed data from all patients diagnosed with severe aortic stenosis at a Veterans Affairs medical facility between January 1997 and April 2008. RESULTS: Of 345 patients with severe aortic stenosis, 260 (75%) underwent surgical evaluation, and 205 (59%) underwent aortic valve replacement (AVR). The patient's decision to decline surgical referral or AVR (n = 47) and severe comorbidities (n = 34) were the top two reasons for medical treatment rather than AVR. The AVR group was younger (69.5 +/- 9.6 years versus 75.7 +/- 8.6 years; p < 0.001) and had a higher prevalence of symptoms (96% versus 71%; p < 0.001) than the medical group. The medical group had a lower cardiac ejection fraction (0.42 +/- 0.15 versus 0.50 +/- 0.12; p < 0.001) and was less likely to be independent in activities of daily living (64% versus 74%). The AVR group had higher survival rates than the medical patients at 1 year (92% versus 65%), 3 years (85% versus 29%), and 5 years (73% versus 16%; log-rank test p < 0.0001). Valve replacement was independently associated with decreased mortality (hazard ratio, 0.17; 95% confidence interval, 0.10 to 0.27; p < 0.0001). CONCLUSIONS: The management of severe aortic stenosis in veterans is sometimes limited to medical evaluation and treatment. Surgeons should be involved in the complex process of risk assessment, to select patients with severe aortic stenosis who would benefit from the survival advantage associated with AVR. |
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Authors:
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Faisal G Bakaeen; Danny Chu; Mark Ratcliffe; Raja R Gopaldas; Alvin S Blaustein; Raghunandan Venkat; Joseph Huh; Scott A LeMaire; Joseph S Coselli; Blase A Carabello |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 89 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-27 Completed Date: 2010-02-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 453-8 Citation Subset: AIM; IM |
Copyright Information:
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2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiothoracic Surgery, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA. fbakaeen@bcm.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Activities of Daily Living
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classification Aged Aged, 80 and over Aortic Valve Stenosis / mortality, surgery* Blood Vessel Prosthesis Implantation* Cardiac Output, Low / mortality, surgery Cardiovascular Agents / therapeutic use Comorbidity Echocardiography Female Health Status Indicators Hospitals, Veterans Humans Male Middle Aged Postoperative Complications / mortality* Prognosis Proportional Hazards Models Retrospective Studies Risk Assessment Survival Rate Treatment Refusal Veterans* |
| Chemical | |
Reg. No./Substance:
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0/Cardiovascular Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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