30 Severe aortic stenosis management in a tertiary cardiac centre. (4th June 2021)

• Record Type: Journal Article
• Authors: Al-Refaie, Norildin; Jarral, Waqas; Shetye, Abhishek; Cassar, Mark; Newton, Jim
• Is Part Of: Heart. Volume 107(2021)Supplement 1
• Page Start: A27
• Page End: A28
• Publication Date: 2021-06-04
• Subjects: Aortic stenosis -- Surgical AVR -- TAVI; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2021-BCS.30
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Aortic stenosis (AS) is the most common valvular heart disease in developed countries with an estimated prevalence of 3%. According to ESC/EACTS guidelines, invasive management is recommended in patients with severe symptomatic AS, because of dismal spontaneous prognosis. It was reported that the average survival durations of patients with severe AS after developing symptoms such as angina, syncope, and shortness of breath were only 5, 3 and 2 years respectively if managed conservatively. Management of asymptomatic severe AS remains controversial. Purpose: Assess the prevalence of symptoms in patients with severe AS, and their management plans in relation with symptoms and age. Method: Retrospective data analysis of 259 patients with severe AS in a tertiary cardiac centre. Clinic notes, operation sheets, procedure reports and discharge summaries were the main source of data. Results: 199 (76.8%) patients were symptomatic (shortness of breath, chest pain, dizziness or syncope). 143 (71.8%) of these underwent intervention (surgical aortic valve replacement (SAVR), transcatheter valve implantation (TAVI) or Valvuloplasty). 56 (28.2%) were managed conservatively (reasons for this being high risk for intervention, technical inadequacy for TAVI and patient informed decision). 9 (4.5%) patients passed away during the study duration (all were managed conservatively).60 (23.2%) patients were asymptomatic, of which 8 (13.3%) underwent intervention. None of medically managed asymptomatic patients passed away during the study period. Average age for symptomatic patients who had surgical AVR±CABG was 73.8 years, whilst average age for patients who had TAVI was 83.9 years, otherwise average age for valvuloplasty and medical treatment groups were 83.6 and 85.6 years respectively. Conclusion: Almost 3 out of each 4 patients with severe AS followed up in a tertiary cardiac centre were symptomatic, and more than two thirds of them underwent intervention. On average patients who had surgical AVR±CABG were almost a decade younger than patients in other treatment groups including patients who had TAVI, valvuloplasty and medical treatment. Most of the patients with asymptomatic severe AS were managed conservatively. This study highlights the high prevalence of symptoms within this population, and has proven useful to estimate the number of annual procedures required based on the number of symptomatic patients. Conflict of Interest: None