Impact of selected comorbidities on the presentation and management of aortic stenosis. Issue 2 (23rd July 2020)

• Record Type: Journal Article
• Authors: Rudolph, Tanja K.; Messika-Zeitoun, David; Frey, Norbert; Thambyrajah, Jeetendra; Serra, Antonio; Schulz, Eberhard; Maly, Jiri; Aiello, Marco; Lloyd, Guy; Bortone, Alessandro Santo; Clerici, Alberto; Delle-Karth, Georg; Rieber, Johannes; Indolfi, Ciro; Mancone, Massimo; Belle, Loic; Lauten, Alexander; Arnold, Martin; Bouma, Berto J; Lutz, Matthias; Deutsch, Cornelia; Kurucova, Jana; Thoenes, Martin; Bramlage, Peter; Steeds, Richard P.
• Is Part Of: Open heart. Volume 7:Issue 2(2020)
• Publication Date: 2020-07-23
• Subjects: aortic valve disease -- prosthetic heart valves -- cardiac surgery; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2020-001271
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Background: Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. Methods: Prospective registry of severe patients with AS across 23 centres in nine European countries. Results: Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. Conclusions: Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.