Transcatheter aortic valve implantation decreases the rate of unoperated aortic stenosis

• Published in: European journal of cardio-thoracic surgery 2011-07, Vol.40 (1), p.43-48
• Main Authors: Malaisrie, S. Chris, Tuday, Eric, Lapin, Brittany, Wang, Edward, Lee, Richard, McGee, Edwin C., Davidson, Charles, McCarthy, Patrick M.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization - methods; Cardiology. Vascular system; Contraindications; Endocardial and cardiac valvular diseases; Epidemiologic Methods; Female; Heart; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - statistics & numerical data; Humans; Male; Medical sciences; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - statistics & numerical data; Pneumology; Referral and Consultation - statistics & numerical data; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Ultrasonography
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.11.031

Abstract Objective: Aortic valve replacement (AVR) is the standard treatment for severe, symptomatic aortic stenosis (AS). However, many patients are not referred for surgery and fewer undergo AVR. Transcatheter aortic valve implantation (TAVI) has emerged as a solution for high-risk AS patients. We sought to measure the impact of TAVI on the undertreatment of AS. Methods: Patients with AS were identified by retrospective medical record review and evaluation of echocardiograms were performed in a single-center tertiary-care institution. A total of 179, 183, 214, and 265 patients had AS in 2006, 2007, 2008, and 2009, respectively, with the introduction of TAVI occurring in 2008 and continuing through 2009. The primary endpoints were the rates of unoperated AS and surgical referral. Results: The rates of unoperated AS were 50.6% before TAVI and 40.7% after TAVI (p=0.002). Referral rates to surgery were 63.6% before TAVI and 74.1% after TAVI (p=0.003). Reasons for nonreferral were patient-family decision, perceived high operative risk, and the presence of comorbidities. Operative mortality was 3.7% and not statistically significant different between years. Three-year patient survival was 82.5% in the AVS group and 43.9% in the UNOP group (p