Current decision making and short-term outcome in patients with degenerative aortic stenosis: The pooled-Rotterdam-Milano-Toulouse in collaboration aortic stenosis survey

Nicolas M. Van Mieghem, Nicolas Dumonteil, Alaide Chieffo, Yann Roux, Robert M A Van Der Boon, Gennaro Giustino, Eline Hartman, Yaar Aga, Louis De Jong, Moussa Abi Ghanem, Bertrand Marcheix, Caterina Cavazza, Didier Carrié, Antonio Colombo, Arie Pieter Kappetein, Peter P T De Jaegere, Didier Tchetche

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: The aim of this study was to provide a real-world snapshot of contemporary Heart Team decision making on patients with aortic stenosis (AS) and the consequent short-term clinical outcome. Methods and results: This was an international multicentre prospective registry encompassing 390 patients with symptomatic severe AS who were prospectively enrolled. Clinical endpoints and the decisive arguments to opt for surgical or transcatheter aortic valve replacement, or medical therapy were recorded separately. The mean age was 76.4±11.6 years, 55% were male and the STS score was 2.9% (IQR 1.6-6.9). The local Heart Teams considered 43%, 25% and 23% to be at low, intermediate and high operative risk with a calculated STS score of 2.18±1.72, 5.08±2.76 and 13.15±9.43, respectively. Overall, 7% were deemed inoperable. Ninety-four percent of patients at low operative risk were sent for SAVR whereas 64% and 92% of intermediate and high-risk patients underwent TAVI. Only 6% of patients did not receive any kind of aortic valve replacement. Overall, 30-day all-cause mortality was 2.8%. TAVI was associated with more major vascular complications, need for permanent pacemakers and post-procedural aortic regurgitation. SAVR had more life-threatening bleedings and new-onset atrial fibrillation. Conclusions: The PRAGMATIC AS survey offers a snapshot of the contemporary management of patients with symptomatic severe AS. Multidisciplinary Heart Teams select an optimal strategy based on age, frailty and comorbidities. Nearly half of all patients are sent for TAVI. Only a small minority of patients will not receive valve replacement therapy.

Original languageEnglish
Pages (from-to)e1305-e1313
JournalEuroIntervention
Volume11
Issue number11
DOIs
Publication statusPublished - Feb 1 2016

Keywords

  • Aortic stenosis
  • Heart Team
  • Transcatheter aortic valve implantation (TAVI)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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