Document Detail

Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?
MedLine Citation:
PMID:  19303794     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Symptomatic severe aortic stenosis is an indication for aortic valve replacement. Some patients are denied intervention. This study provides insight into the proportion of conservatively treated patients and into the reasons why conservative treatment is chosen. METHODS: Of a patient cohort presenting with severe aortic stenosis between 2004 and 2007, medical records were retrospectively analyzed. Only symptomatic patients (n=179) were included. We studied their characteristics, treatment decisions, and survival. RESULTS: Mean age was 71 years, 50% were male. During follow-up (mean 17 months, 99% complete) 76 (42%) patients were scheduled for surgical treatment (63 conventional valve replacement, 10 transcatheter, 1 heart transplantation, 2 waiting list) versus 101 (56%) who received medical treatment. Reasons for medical treatment were: perceived high operative risk (34%), symptoms regarded mild (19%), stenosis perceived non-severe (14%), and patient preference (9%). In 5% the decision was pending at the time of the analysis and in 20% the reason was other/unclear. Mean age of the surgical group was 68 years versus 73 years for medically treated patients (p=0.004). Predicted mortality (EuroSCORE) was 7.8% versus 11.3% (p=0.006). During follow-up 12 patients died in the surgical group (no 30-day operative mortality), versus 28 in the medical group. Two-year survival was 90% versus 69%. CONCLUSIONS: A large proportion (56%) of symptomatic patients does not undergo aortic valve replacement. Often operative risk is estimated (too) high or hemodynamic severity and symptomatic status are misclassified. Interdisciplinary team discussions between cardiologists and surgeons should be encouraged to optimize patient selection for surgery.
Martijn W A van Geldorp; Menno van Gameren; Arie Pieter Kappetein; Bardia Arabkhani; Lotte E de Groot-de Laat; Johanna J M Takkenberg; Ad J J C Bogers
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-03-20
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  35     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-07-15     Revised Date:  2010-02-11    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  953-7; discussion 957     Citation Subset:  IM    
Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Room Bd 575, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / mortality,  surgery*
Attitude of Health Personnel
Decision Making
Epidemiologic Methods
Heart Valve Prosthesis Implantation / contraindications,  utilization*
Middle Aged
Netherlands / epidemiology
Patient Selection
Treatment Outcome
Comment In:
Eur J Cardiothorac Surg. 2010 Feb;37(2):497; author reply 498   [PMID:  19775902 ]
Eur J Cardiothorac Surg. 2009 Jun;35(6):958-9   [PMID:  19329334 ]

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