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Very severe aortic stenosis: Is there a price to pay for late treatment?
Authors : C Strong (Carnaxide,PT), MJ Andrade (Carnaxide,PT), G Cardoso (Carnaxide,PT), C Reis (Carnaxide,PT), E Horta (Carnaxide,PT), G Rodrigues (Carnaxide,PT), A Oliveira (Carnaxide,PT), M Mendes (Carnaxide,PT)
Background: Very severe aortic stenosis (AS), even in asymptomatic patients, has been associated with a poor prognosis with a greater risk of events and faster functional deterioration. For this reason, preventive elective valve replacement has been advocated even in asymptomatic patients, particularly when operative risk is low.
Purpose: To evaluate the prevalence of very severe AS and to compare clinical and echocardiographic characteristics, therapeutic management and overall survival between this group and those with severe AS, both groups with preserved left ventricular ejection fraction (LVEF).
Methods: Single center, retrospective study of patients with AS diagnosed by transthoracic echocardiography between January 2014 and December 2015. All patients with symptomatic very severe and severe aortic stenosis and normal LVEF were selected. Clinical, echocardiographic and follow-up data were collected. Very severe AS was defined as a mean gradient (MG) >60 mmHg or a peak transvalvular velocity > 5.5 m/s.
Results: Out of the 450 patients with AS identified in this time window, 92 had severe AS (mean age 77±10 years-old, 52% female) and 77 very severe AS (mean age 76±10, 57% female). For very severe AS patients, aortic valve area (AVA) was 0.63±0.2 cm2 and MG of 72 mmHg; for severe AS patients, AVA was 0.76±0.1 cm2 and MG was 48±6 mmHg. Out of a total of 169 patients, 131 were submitted to valve replacement, 104 patients by conventional surgery and 24 by TAVI, while the remaining were left on medical therapy. Follow-up was undertaken for a mean of 26 months. There was no difference in the chosen therapeutic strategy. There was also no difference in overall survival between severe and very severe AS even after valve replacement.
Conclusions: In our population of patients with severe AS and preserved LVEF, many of them had very severe AS. The greater severity of AS did not have an impact on outcome after treatment, suggesting that it is never too late to intervene in these patients.
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