Impact of selected comorbidities on the presentation and management of aortic stenosis

Tanja K. Rudolph, David Messika-Zeitoun, Norbert Frey, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly, Marco Aiello, Guy Lloyd, Alessandro Santo Bortone, Alberto Clerici, Georg Delle-Karth, Johannes Rieber, Ciro Indolfi, Massimo Mancone, Loic Belle, Alexander Lauten, Martin Arnold, Berto J. Bouma, Matthias LutzCornelia Deutsch, Jana Kurucova, Martin Thoenes, Peter Bramlage, Richard P. Steeds

Research output: Contribution to journalArticle

Abstract

Background Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. Methods Prospective registry of severe patients with AS across 23 centres in nine European countries. Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. Conclusions Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.

Original languageEnglish
Article numbere001271
JournalOpen Heart
Volume7
Issue number2
DOIs
Publication statusPublished - Jul 23 2020

Keywords

  • aortic valve disease
  • cardiac surgery
  • prosthetic heart valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Rudolph, T. K., Messika-Zeitoun, D., Frey, N., Thambyrajah, J., Serra, A., Schulz, E., Maly, J., Aiello, M., Lloyd, G., Bortone, A. S., Clerici, A., Delle-Karth, G., Rieber, J., Indolfi, C., Mancone, M., Belle, L., Lauten, A., Arnold, M., Bouma, B. J., ... Steeds, R. P. (2020). Impact of selected comorbidities on the presentation and management of aortic stenosis. Open Heart, 7(2), [e001271]. https://doi.org/10.1136/openhrt-2020-001271