Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

Abstract

Background and ObjectivesAortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis.MethodsFrom January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR.ResultsAfter screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p<0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p<0.001, p<0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality.ConclusionsIn elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

“…Previous studies have shown that the degree of anemia is associated with the degree of severity of aortic stenosis, and patients with severe aortic stenosis and severe anemia have a higher mortality rate [30,31]. Nagao et al assessed the impact of anemia on cardiovascular and bleeding outcomes in 3,403 patients enrolled in the CURRENT aortic stenosis registry, and they found that moderate and/or severe anemia was associated with a significantly increased risk for this primary outcome measure as well as for major bleeding [32].…”

Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment

“…Increasing systemic vascular resistance and stiffness may also contribute to the vicious circle of DAS [6]. Once symptoms of DAS develop, life expectancy is shortened to around 3 years unless the mechanical obstruction to left ventricular outflow is relieved by aortic valve replacement [7][8][9][10].…”

Natural History Data in Symptomatic Severe Aortic Stenosis Alerts Cardiologists to the Dangers of No Action

“…This study found a lower mortality rate than previous studies did: one-year mortality rates ranged from 33.5% in one study of unoperated symptomatic severe AS patients,4) 38% in another study of unoperated severe AS patients,6) up to 50.7% in inoperable symptomatic severe AS patients in the Placement of Aortic Transcatheter Valves (PARTNER) trial 7). One main reason may be that the study by Oh et al5) enrolled the ‘younger’ elderly AS patients (78±7 years), whereas the mean age of AS patients enrolled in the PARTNER trial was 83.1±8.6 years. Since age itself is one of the most important unmodifiable risk factors of mortality, it seems that the study by Oh et al5) recruited AS patients at a somewhat lower risk.…”

“…AS patients who could not undergo surgical correction for various reasons can now achieve longevity with greater quality of life through TAVR, and thus, the number of AS patients treated medically is expected to decrease. In this respect, the article given by Oh et al5) in this issue of the Korean Circulation Journal may seem to be outdated. Notwithstanding, we believe that this article is of value, because no data has hitherto been published regarding the portion of AS patients in Korea being treated medically.…”

“…Let's briefly go over Oh et al's data 5). They investigated the survival of severe ‘symptomatic’ AS patients who refused SAVR.…”