Maarleveld, W.H. (2012) Symptomatic severe aortic stenosis: reasons for withholding aortic valve replacement. thesis, Medicine.
Full text available on request.Abstract
Introduction: With the ageing of our population, prevalence of aortic stenosis (AS) is increasing. Patients with symptomatic severe AS have an augmented risk of sudden death and myocardial infarction. Typically, patients stay asymptomatic for a long time, but from the moment symptoms develop, the median survival is just 2-3 years. The only effective treatment is aortic valve replacement (AVR), after which the life expectancy is nearly equal to the life expectancy in the healthy population. However, it is known from literature that about a third of symptomatic patients is not referred for surgery. Aim: To determine the reasons for withholding surgery in patients with symptomatic severe aortic stenosis and to compare survival in patients treated conservatively with a cohort of patients treated surgically. Material and methods: All patients with symptomatic severe aortic stenosis in the Isala clinics in Zwolle between 2006-2010 were identified. Severe aortic stenosis was defined as a peak gradient >64 mmHg. We retrospectively analysed all patients who were treated conservatively. The reasons for denying surgery were identified, and survival was compared with a database with patients who underwent aortic valve replacement. Results: 134 (40 men, 94 women) conservatively treated patients and 1245 (714 men, 531 women) patients who underwent AVR were evaluated. Respectively, mean age was 84 (SD 4.8) and 72 (SD 8.8) (p=<0.0001), median logistic EuroSCORE was 18.5% (IQR 12.3% - 29.3%) and 8.2% (IQR 4.8% - 15.0%) (p=<0.0001). Main reasons for conservative treatment were co-morbidity (38%), old age (31%), high surgical risk (27%) and frailty (21%). Survival was markedly lower for patients treated conservatively (p= <0.0001). Conclusions: There are many reasons for withholding from surgery. The most important reason is co-morbidity. As expected, mortality in the conservatively treated cohort is very high. A next study could be a prospective trial which tries to identify the patient characteristics that make patients suitable candidates for Transcatheter Aortic Valve Implantiation (TAVI) or even AVR.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervision: and Nierich, Dr. A. thoraxanaesthesist and Location: Thoraxanaestesiology, Isala Clinics |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/823 |
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