This article is more than 5 years old. Information may no longer be current.

Early surgical AVR better than ‘watchful waiting’ in asymptomatic aortic stenosis

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

SAN FRANCISCO — Using a conservative strategy to manage patients with severe aortic stenosis led to bleak long-term outcomes, suggesting improvements would be reaped with earlier surgical aortic valve replacement, according to Japanese researchers.

“The current guidelines recommend the strategy of watchful waiting for AVR until symptoms emerge in asymptomatic patients with severe [aortic stenosis] except for several subgroups of patients such as those with left ventricular dysfunction or those with very severe [aortic stenosis],” Tomohiko Taniguchi, MD, of the department of cardiovascular medicine at Kyoto University Graduate School of Medicine, Japan, said in a presentation.

Tomohiko
Taniguchi

Taniguchi and colleagues retrospectively assessed outcomes of 3,815 patients with severe aortic stenosis in the CURRENT AS multicenter registry.

These patients, consecutively enrolled from 2003 to 2011, had aortic jet velocity of more than 4 m/s at peak, average aortic pressure gradient of more than 40 mm Hg, or aortic valve area of less than 1 cm².

The investigators focused on 1,808 patients who were experiencing no symptoms. Surgical AVR was performed in 291 patients, whereas 1,517 patients were treated conservatively. The investigators conducted follow-up at an average of 1,361 days; the follow-up rate at 2 years was 90%.

A propensity-score matched group of 582 patients — evenly divided based on initial surgical AVR and conservative strategy — served as the main analysis population.

Baseline characteristics were comparable between groups; patients who underwent initial surgical AVR were slighter younger and had greater stenosis severity. During the follow-up period, 41% of patients with conservative strategy underwent surgical AVR.

Compared with watchful waiting, initial surgical AVR was associated with lower cumulative 5-year incidence of all-cause death (15.4% vs. 26.4%; P = .009) and hospitalization for HF (3.8% vs. 19.9%; P < .001).

Further, multivariable Cox models in the entire cohort showed results that were consistent with the propensity-scored matched analysis.

“We can conclude that the long-term outcome of asymptomatic patients with severe [aortic stenosis] was dismal when managed conservatively in real clinical practice, which might be substantially improved by the initial AVR strategy,” Taniguchi said.

Further investigation, particularly randomized controlled trials, is needed to compare the initial AVR and conservative strategies for the management of this patient population, according to the researchers. – by Allegra Tiver

Reference:

Taniguchi T, et al. Evaluation of initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis. Presented at: TCT Scientific Symposium; Oct. 11-15, 2015; San Francisco.

Taniguchi T, et al. J Am Coll Cardiol. 2015; doi:10.1016/j.jacc.2015.10.001.

Disclosure: Taniguchi reports no relevant financial disclosures.