PURPOSE: Assess prevalence of adult patients with severe Aortic Stenosis (AS) who do not undergo Aortic Valve Replacement (AVR) and the reasons associated with non-surgical therapy.
METHODS: Patient records were selected from a single-center using criteria from the 2006 American College of Cardiology/American (ACC/AHA) guidelines for classification of severe AS based on average valve area<1.0 cm2 or aortic mean valve gradient > 40 mmHG. 101 patients who had severe AS were retrospecitively identified from a 2007 database query. Clinical data were examined to determine indications for intervention and whether intervention was performed (Chart 1).
RESULTS: 101 patients with severe AS, 74 (73%) did not undergo surgical intervention while (27%) had AVR. Of the patients without AVR 38 (51%) exhibited symptoms related to AS while the other 36 patients' records indicated no symptoms or symptom status was unavailable. The unoperated patients 35 male and 39 female, had a mean age of 81 years old (50-96). Left ventricular dysfunction was shown in 14% of unoperated patients. The average predicted risk of operative mortality was 15.6% for unoperated patients.The primary reason symptomatic AS patients did not undergo AVR was their symptoms were attributed to other etiologies (Chart 2). For the unoperated patients without symptoms, the most frequent reason in opposition to surgery was lack of patient symptoms. However, less than 1/3 of the 36 asymptomatic patients were stress-tested to elicit symptoms. The second most common reason for lack of intervention was that hemodynamic results were not considered severe despite falling within ACC/AHA guideline classification of severe AS.
CONCLUSION: Surgical intervention occurred in one-quarter of the population. However, accepted guideline indications for intervention were present in at least half of the unoperated patients. This retrospective study is evidence that severe aortic stenosis may be under-treated and thereby precluding patients from receiving potentially life-saving and life-improving AVR surgery.
CLINICAL IMPLICATIONS: Changes of referral patterns in patients with severe AS to reflect ACC/AHA guidelines.
DISCLOSURE: Junaid Khan, Grant monies (from industry related sources) Alta Bates Summit Medical Center,Research and Education Institute received a grant from Edwards Lifesciences to conduct this retrospective study.; Consultant fee, speaker bureau, advisory committee, etc. Junaid H. Khan is on the speaker bureau for the Edwards Lifesciences.; No Product/Research Disclosure Information