Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery

John Campo, Andrea Tsoris, Jane Kruse, Azad Karim, Adin-Cristian Andrei, Menghan Liu, Robert O Bonow, Patrick M McCarthy, S Chris Malaisrie*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: This study sought to determine outcomes in patients with severe, asymptomatic aortic stenosis (AS), stratified by treatment recommendation. Methods: Between January 2005 and December 2013, 4,998 patients had severe AS by echocardiography, of whom 308 were identified as asymptomatic by medical record review. Five patients were deemed inoperable, and 38 were lost to follow-up. Of the remaining 265 patients, aortic valve replacement (AVR) was recommended in 104, and watchful waiting (WW) was recommended in 161. Probabilities of undergoing surgery and of death from recommendation date were estimated using a multistate model. Cox regression analysis was used to determine independent risk factors for death. Results: Probability of death at 1 year after recommendation was 5.2% in the WW group and 4.7% in the AVR group. At 2 years after recommendation, survival in the AVR-recommended group was 92.5% versus 83.9% in the WW group (p = 0.044). In the WW group, the probability of dying or undergoing surgery was 43.9% by 2 years. Undergoing surgery was independently associated with higher survival in the AVR-recommended group (hazard ratio [HR], 0.17; p = 0.038) and in the WW group (HR, 0.39; p = 0.044). A higher ejection fraction (HR, 0.58; p < 0.001) was associated with better survival, whereas renal failure (HR, 2.81; p = 0.009) was associated with worse survival. Conclusions: The strategy of early AVR is associated with improved survival in asymptomatic patients.

Original languageEnglish (US)
Pages (from-to)74-79
Number of pages6
JournalAnnals of Thoracic Surgery
Volume108
Issue number1
DOIs
StatePublished - Jul 1 2019

Fingerprint

Watchful Waiting
Aortic Valve Stenosis
Aortic Valve
Survival
Lost to Follow-Up
Medical Records
Renal Insufficiency
Echocardiography
Regression Analysis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery",
abstract = "Background: This study sought to determine outcomes in patients with severe, asymptomatic aortic stenosis (AS), stratified by treatment recommendation. Methods: Between January 2005 and December 2013, 4,998 patients had severe AS by echocardiography, of whom 308 were identified as asymptomatic by medical record review. Five patients were deemed inoperable, and 38 were lost to follow-up. Of the remaining 265 patients, aortic valve replacement (AVR) was recommended in 104, and watchful waiting (WW) was recommended in 161. Probabilities of undergoing surgery and of death from recommendation date were estimated using a multistate model. Cox regression analysis was used to determine independent risk factors for death. Results: Probability of death at 1 year after recommendation was 5.2{\%} in the WW group and 4.7{\%} in the AVR group. At 2 years after recommendation, survival in the AVR-recommended group was 92.5{\%} versus 83.9{\%} in the WW group (p = 0.044). In the WW group, the probability of dying or undergoing surgery was 43.9{\%} by 2 years. Undergoing surgery was independently associated with higher survival in the AVR-recommended group (hazard ratio [HR], 0.17; p = 0.038) and in the WW group (HR, 0.39; p = 0.044). A higher ejection fraction (HR, 0.58; p < 0.001) was associated with better survival, whereas renal failure (HR, 2.81; p = 0.009) was associated with worse survival. Conclusions: The strategy of early AVR is associated with improved survival in asymptomatic patients.",
author = "John Campo and Andrea Tsoris and Jane Kruse and Azad Karim and Adin-Cristian Andrei and Menghan Liu and Bonow, {Robert O} and McCarthy, {Patrick M} and Malaisrie, {S Chris}",
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Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery. / Campo, John; Tsoris, Andrea; Kruse, Jane; Karim, Azad; Andrei, Adin-Cristian; Liu, Menghan; Bonow, Robert O; McCarthy, Patrick M; Malaisrie, S Chris.

In: Annals of Thoracic Surgery, Vol. 108, No. 1, 01.07.2019, p. 74-79.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognosis of Severe Asymptomatic Aortic Stenosis With and Without Surgery

AU - Campo, John

AU - Tsoris, Andrea

AU - Kruse, Jane

AU - Karim, Azad

AU - Andrei, Adin-Cristian

AU - Liu, Menghan

AU - Bonow, Robert O

AU - McCarthy, Patrick M

AU - Malaisrie, S Chris

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: This study sought to determine outcomes in patients with severe, asymptomatic aortic stenosis (AS), stratified by treatment recommendation. Methods: Between January 2005 and December 2013, 4,998 patients had severe AS by echocardiography, of whom 308 were identified as asymptomatic by medical record review. Five patients were deemed inoperable, and 38 were lost to follow-up. Of the remaining 265 patients, aortic valve replacement (AVR) was recommended in 104, and watchful waiting (WW) was recommended in 161. Probabilities of undergoing surgery and of death from recommendation date were estimated using a multistate model. Cox regression analysis was used to determine independent risk factors for death. Results: Probability of death at 1 year after recommendation was 5.2% in the WW group and 4.7% in the AVR group. At 2 years after recommendation, survival in the AVR-recommended group was 92.5% versus 83.9% in the WW group (p = 0.044). In the WW group, the probability of dying or undergoing surgery was 43.9% by 2 years. Undergoing surgery was independently associated with higher survival in the AVR-recommended group (hazard ratio [HR], 0.17; p = 0.038) and in the WW group (HR, 0.39; p = 0.044). A higher ejection fraction (HR, 0.58; p < 0.001) was associated with better survival, whereas renal failure (HR, 2.81; p = 0.009) was associated with worse survival. Conclusions: The strategy of early AVR is associated with improved survival in asymptomatic patients.

AB - Background: This study sought to determine outcomes in patients with severe, asymptomatic aortic stenosis (AS), stratified by treatment recommendation. Methods: Between January 2005 and December 2013, 4,998 patients had severe AS by echocardiography, of whom 308 were identified as asymptomatic by medical record review. Five patients were deemed inoperable, and 38 were lost to follow-up. Of the remaining 265 patients, aortic valve replacement (AVR) was recommended in 104, and watchful waiting (WW) was recommended in 161. Probabilities of undergoing surgery and of death from recommendation date were estimated using a multistate model. Cox regression analysis was used to determine independent risk factors for death. Results: Probability of death at 1 year after recommendation was 5.2% in the WW group and 4.7% in the AVR group. At 2 years after recommendation, survival in the AVR-recommended group was 92.5% versus 83.9% in the WW group (p = 0.044). In the WW group, the probability of dying or undergoing surgery was 43.9% by 2 years. Undergoing surgery was independently associated with higher survival in the AVR-recommended group (hazard ratio [HR], 0.17; p = 0.038) and in the WW group (HR, 0.39; p = 0.044). A higher ejection fraction (HR, 0.58; p < 0.001) was associated with better survival, whereas renal failure (HR, 2.81; p = 0.009) was associated with worse survival. Conclusions: The strategy of early AVR is associated with improved survival in asymptomatic patients.

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U2 - 10.1016/j.athoracsur.2019.01.031

DO - 10.1016/j.athoracsur.2019.01.031

M3 - Article

VL - 108

SP - 74

EP - 79

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -