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Initial Surgical Versus Conservative Strategies in Patients With Asymptomatic Severe Aortic Stenosis.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Taniguchi, Tomohiko Morimoto, Takeshi Shiomi, Hiroki Ando, Kenji Kanamori, Norio Murata, Koichiro Kitai, Takeshi Kawase, Yuichi Izumi, Chisato Miyake, Makoto Mitsuoka, Hirokazu Kato, Masashi Hirano, Yutaka Matsuda, Shintaro Nagao, Kazuya Inada, Tsukasa Murakami, Tomoyuki Takeuchi, Yasuyo Yamane, Keiichiro Toyofuku, Mamoru Ishii, Mitsuru Minamino-Muta, Eri Kato, Takao Inoko, Moriaki Ikeda, Tomoyuki Komasa, Akihiro Ishii, Katsuhisa Hotta, Kozo Higashitani, Nobuya Kato, Yoshihiro Inuzuka, Yasutaka Chiyo Jinnai, Toshikazu Morikami, Yuko Sakata, Ryuzo Kimura, Takeshi |
| Copyright Year | 2015 |
| Abstract | BACKGROUND Current guidelines generally recommend watchful waiting until symptoms emerge for aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS). OBJECTIVES The study sought to compare the long-term outcomes of initial AVR versus conservative strategies following the diagnosis of asymptomatic severe AS. METHODS We used data from a large multicenter registry enrolling 3,815 consecutive patients with severe AS (peak aortic jet velocity >4.0 m/s, or mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm(2)) between January 2003 and December 2011. Among 1,808 asymptomatic patients, the initial AVR and conservative strategies were chosen in 291 patients, and 1,517 patients, respectively. Median follow-up was 1,361 days with 90% follow-up rate at 2 years. The propensity score-matched cohort of 582 patients (n = 291 in each group) was developed as the main analysis set for the current report. RESULTS Baseline characteristics of the propensity score-matched cohort were largely comparable, except for the slightly younger age and the greater AS severity in the initial AVR group. In the conservative group, AVR was performed in 41% of patients during follow-up. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group than in the conservative group (15.4% vs. 26.4%, p = 0.009; 3.8% vs. 19.9%, p < 0.001, respectively). CONCLUSIONS The long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140). |
| Starting Page | 2827 |
| Ending Page | 2838 |
| Page Count | 12 |
| File Format | PDF HTM / HTML |
| DOI | 10.1016/j.jacc.2015.10.001 |
| Alternate Webpage(s) | http://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20Programs/Valve-Meeting/Taniguchi-2015.pdf |
| Alternate Webpage(s) | http://www.revportcardiol.org/index.php?p=revista&pii=S217420491600060X&tipo=pdf-simple |
| Alternate Webpage(s) | https://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/225456/3/gigak04190.pdf |
| PubMed reference number | 26477634 |
| Alternate Webpage(s) | https://doi.org/10.1016/j.jacc.2015.10.001 |
| Journal | Medline |
| Volume Number | 66 |
| Issue Number | 25 |
| Journal | Journal of the American College of Cardiology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
