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Long-term outcome of elderly patients with severe aortic stenosis as a function of treatment modality
  1. Thomas Pilgrim1,
  2. Lars Englberger2,
  3. Martina Rothenbühler3,
  4. Stefan Stortecky1,
  5. Osman Ceylan1,
  6. Crochan J O'Sullivan1,
  7. Christoph Huber2,
  8. Fabien Praz1,
  9. Lutz Buellesfeld1,
  10. Bettina Langhammer2,
  11. Bernhard Meier1,
  12. Peter Jüni3,
  13. Thierry Carrel2,
  14. Stephan Windecker1,
  15. Peter Wenaweser1
  1. 1Department of Cardiology, Bern University Hospital, Bern, Switzerland
  2. 2Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
  3. 3Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
  1. Correspondence to Dr Peter Wenaweser, Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, CH-3010 Bern, Switzerland; peter.wenaweser{at}insel.ch

Abstract

Objective To assess long-term clinical outcomes of consecutive high-risk patients with severe aortic stenosis according to treatment allocation to transcatheter aortic valve implantation (TAVI), surgical aortic valve replacement (SAVR) or medical treatment (MT).

Methods Patients with severe aortic stenosis were consecutively enrolled into a prospective single centre registry.

Results Among 442 patients (median age 83 years, median STS-score 4.7) allocated to MT (n=78), SAVR (n=107), or TAVI (n=257) all-cause mortality amounted to 81%, 37% and 43% after a median duration of follow-up of 3.9 years (p<0.001). Rates of major adverse cerebro-cardiovascular events were lower in patients undergoing SAVR or TAVI as compared with MT (SAVR vs MT: HR 0.31, 95% CI 0.21 to 0.46) (TAVI vs MT: HR 0.34, 95% CI 0.25 to 0.46), with no significant difference between SAVR and TAVI (HR 0.88, 95% CI 0.62 to 1.25). Whereas SAVR (HR 0.39, 95% CI 0.24 to 0.61), TAVI (HR 0.37, 95% CI 0.26 to 0.52), and female gender (HR 0.72, 95% CI 0.53 to 0.99) were associated with improved survival, body mass index ≤20 kg/m2 (HR 1.60, 95% CI 1.04 to 2.47), diabetes (HR 1.48, 95% CI 1.03 to 2.12), peripheral vascular disease (HR 2.01, 95% CI 1.44 to 2.81), atrial fibrillation (HR 1.74, 95% CI 1.28 to 2.37) and pulmonary hypertension (HR 1.43, 95% CI 1.03 to 2.00) were identified as independent predictors of mortality.

Conclusions Among high-risk patients with severe aortic stenosis, long-term clinical outcome through 5 years was comparable between patients allocated to SAVR or TAVI. In contrast, patients with MT had a dismal prognosis.

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