Clinical profile and outcome of patients with severe aortic stenosis at high surgical risk: single-center prospective evaluation according to treatment assignment
| Autor: | Danny, Dvir, Alexander, Sagie, Eyal, Porat, Abid, Assali, Yaron, Shapira, Hana, Vaknin-Assa, Gideon, Shafir, Tamir, Bental, Roman, Nevzorov, Alexander, Battler, Ran, Kornowski |
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| Rok vydání: | 2012 |
| Předmět: |
Balloon Valvuloplasty
Male Cardiac Catheterization Time Factors Kaplan-Meier Estimate Prosthesis Design Risk Assessment Severity of Illness Index Risk Factors Humans Prospective Studies Registries Israel Aged Proportional Hazards Models Aged 80 and over Heart Valve Prosthesis Implantation Chi-Square Distribution Patient Selection Hemodynamics Cardiovascular Agents Aortic Valve Stenosis Treatment Outcome Heart Valve Prosthesis Multivariate Analysis Female |
| Zdroj: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 81(5) |
| ISSN: | 1522-726X |
| Popis: | The study sought to assess the clinical profile, outcome, and predictors for mortality of "real-world" high-risk severe aortic stenosis patients according to the mode of treatment assigned.Patients were referred to a dedicated clinic for meticulous screening and multidisciplinary team assessment and 343 were finally assigned treatment (age 81.3 ± 7.2 years, 42.3% men): transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN or CoreValve device, 100 (29.2%); surgical aortic valve replacement (SAVR), 61 (17.8%); balloon valvuloplasty (as definitive therapy), 27 (7.9%); medication only, 155 (45.2%). No patient was lost to follow-up.The balloon valvuloplasty group had a significantly higher 1-month mortality rate (18.5%) than the TAVR group (3%, P = 0.006) and medical therapy group (3.9%; P = 0.004), without significant difference from the SAVR group (11.5%, P = 0.5). One-year cumulative survival was significantly higher in the TAVR group (92%) than in the other groups (SAVR 71%, balloon valvuloplasty 61.5%, medication 65%; all P0.001). Among survivors, 1-year rates of high functional class (NYHA I/II) were as follows: TAVR, 84.6%; SAVR, 63.3%; balloon valvuloplasty, 18.2%; medication, 21.4% (TAVR vs. SAVR, P = 0.04; SAVR vs. balloon valvuloplasty or medical therapy, P = 0.01). On multivariate regression analysis, renal failure (hazard ratio [HR] = 5.3, P0.001), not performing TAVR (HR = 4.9, P0.001), and pulmonary pressure (10 mm Hg, HR = 1.2, P = 0.02) were independent predictors of 1-year mortality.TAVR, performed in carefully selected high-risk patients, is associated with an excellent survival rate and high functional class. Patients treated with another of the available modalities, including SAVR, had a worse outcome, regardless of which alternative treatment they receive. |
| Databáze: | OpenAIRE |
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