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Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis


Objective The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients.

Design A single centre, retrospective cohort study.

Patients and Methods The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity ≥4.0 m/s, or mean aortic pressure gradient (MPG) ≥40 mm Hg, or an aortic valve area (AVA) <1.0 cm2) and 58 patients with very severe AS (a maximal jet velocity ≥5.0 m/s, or MPG ≥50 mm Hg or an AVA <0.6 cm2). Clinical outcomes were compared between the two groups, considering the existence of symptoms.

Main Outcome Measures All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure.

Results Mean follow-up was 5.5±3.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p<0.01; 75% vs 88%, p<0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p<0.01 and p<0.001, respectively).

Conclusions Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.

  • Aortic valve disease
  • dissection
  • mitral regurgitation
  • surgery—valve

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