Unoperated severe aortic stenosis: decision making in an adult UK-based population

作者：Badran A A; Vohra H A; Livesey S A^*

来源：Annals of the Royal College of Surgeons of England, 2012, 94(6): 416-421.

DOI：10.1308/003588412X13171221591817

• Aortic valve stenosis
• Aortic valve
• Heart valve disease
• Echocardiography
• Heart valve prosthesis implantation
• Cardiovascular surgical procedures

INTRODUCTION Severe symptomatic aortic stenosis is associated with a poor prognosis, with most patients dying 2-3 years after diagnosis. We analysed the proportion of patients with severe aortic stenosis not referred for aortic valve replacement (AVR) in a UK-based population and the clinical factors contributing to this.
METHODS Retrospective analysis of patients with echocardiographic evidence of severe aortic stenosis was performed at a university teaching hospital.
RESULTS A total of 178 consecutive patients with severe aortic stenosis (AVA: <1cm(2), mean pressure gradient: >= 40mmHg, or visually severe on echocardiography) were included in the study. Eighty-three patients did not have AVR (95% confidence interval: 39-54%). The cohort included 146 symptomatic patients (82%) and 32 (18%) who were asymptomatic. The most common reason for non-referral in symptomatic patients was 'high operative risk' and in asymptomatic patients no symptoms'. Of the patients who did not have AVR, only 19% (n=16) were referred for a surgical opinion. None of the patients in the asymptomatic group underwent echocardiographic stress imaging. The thirty-day operative mortality rate in the AVR group was 2.3%. Symptomatic patients who underwent AVR had superior survival, even after adjusting for co-morbidities (p<0.001).
CONCLUSIONS A considerable proportion of patients with severe aortic stenosis are not referred for surgery although they have a clear indication for AVR. Patients are often estimated as being too high risk or having prohibitive co-morbidities. Among asymptomatic patients, stress imaging was rarely used despite its useful role prognostically and in deciding the best time for intervention.

• 出版日期2012-9