Management of patients with severe aortic stenosis in the TAVI-era: how recent recommendations are translated into clinical practice

ObjectiveApproximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of s...

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Published in:Open heart 2021-01, Vol.8 (1), p.e001485
Main Authors: Lauten, Alexander, Rudolph, Tanja K, Messika-Zeitoun, David, Thambyrajah, Jeetendra, Serra, Antonio, Schulz, Eberhard, Frey, Norbert, Maly, Jiri, Aiello, Marco, Lloyd, Guy, Bortone, Alessandro Santo, Clerici, Alberto, Delle-Karth, Georg, Rieber, Johannes, Indolfi, Ciro, Mancone, Massimo, Belle, Loic, Arnold, Martin, Bouma, Berto J, Lutz, Matthias, Deutsch, Cornelia, Kurucova, Jana, Thoenes, Martin, Bramlage, Peter, Steeds, Richard Paul
Format: Article
Language:English
Subjects:
Activities of daily living
aortic valve stenosis
Asymptomatic
cardiac surgical procedures
Cardiology
Chronic obstructive pulmonary disease
Clinical medicine
Decision making
Ejection fraction
Frailty
Heart
Medical treatment
Pain
Patients
Pulmonary arteries
Teams
transcatheter aortic valve replacement
Valvular Heart Disease
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Summary:ObjectiveApproximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR.MethodsParticipants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR.ResultsOf 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p
ISSN:2053-3624
2398-595X
2053-3624
DOI:10.1136/openhrt-2020-001485