Treatment Assignment of High-Risk Symptomatic Severe Aortic Stenosis Patients Referred for Transcatheter AorticValve Implantation

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• 作者：Kevin R. Bainey ; MD^a ; ^{kbainey@ualberta.ca} ; Madhu K. Natarajan ; MD ; MSc^b ; ^c ; Mathew Mercuri ; MSc^b ; ^c ; Tony Lai ; MD^b ; ^c ; Kevin Teoh ; MD^b ; ^c ; Victor Chu ; MD^b ; ^c ; Richard P. Whitlock ; MD ; PhD^b ; ^c ; James L. Velianou ; MD^b ; ^c
• 刊名：The American Journal of Cardiology
• 出版年：2013
• 出版时间：1 July, 2013
• 年：2013
• 卷：112
• 期：1
• 页码：100-103
• 全文大小：322 K

文摘

Transcatheter aortic valve implantation (TAVI) has become an option for patients with symptomatic severe aortic stenosis whose co-morbidities place them at high surgical risk. However, little is known regarding treatment allocation. From May 2008 to May 2011, all high-risk patients with symptomatic severe aortic stenosis referred to an experienced single-center TAVI clinic were reviewed. A total of 170 consecutive patients were evaluated. Of these, 58 (34 % ) were accepted for TAVI (mean age 81 ¡À 8 years). Thirty-three patients (19 % ) were accepted for conventional aortic valve replacement (AVR; mean age 83 ¡À 6?years). Sixty-two patients (37 % ) were treated conservatively (mean age 83 ¡À 6 years). Seventeen patients (10 % ) died awaiting complete assessment. At 30 days, all-cause mortality was 10 % in the TAVI group, 3 % in the conventional AVR group, and 32 % in the conservatively treated group. Multivariate-adjustment identified the absence of chronic obstructive pulmonary disease (hazard ratio 0.30, 95 % confidence interval 0.09 to 0.98, p?<0.05) and the absence of frailty (hazard ratio 0.19, 95 % confidence interval 0.07 to 0.55, p <0.01) as independent predictors of conventional AVR. In conclusion, of the high-risk patients with severe aortic stenosis referred for TAVI at a large single center, approximately 1/2 were accepted for intervention (conventional AVR or TAVI), and roughly 1/3 were treated conservatively.