Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis.

Abstract

BACKGROUND:

There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management. Methods and Results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS. Of 1,808 asymptomatic patients, 286 patients initially underwent AVR (initial AVR group), and 377 patients were initially managed conservatively and eventually underwent AVR (AVR after watchful waiting group). Mortality after AVR was compared between the 2 groups. Subgroup analysis according to peak aortic jet velocity (Vmax) at diagnosis was also conducted. There was no significant difference between the 2 groups in 5-year overall survival (OS; 86.0% vs. 84.1%, P=0.34) or cardiovascular death-free survival (DFS; 91.3% vs. 91.1%, P=0.61), but on subgroup analysis of patients with Vmax ≥4.5 m/s at diagnosis, the initial AVR group was superior to the AVR after watchful waiting group in both 5-year OS (88.4% vs. 70.6%, P=0.003) and cardiovascular DFS (91.9% vs. 81.7%, P=0.023).

CONCLUSIONS:

Asymptomatic severe AS patients who underwent AVR after watchful waiting had a postoperative survival rate similar to those who initially underwent AVR. In a subgroup of patients with Vmax ≥4.5 m/s at diagnosis, however, the AVR after watchful waiting group had worse postoperative survival rate than the initial AVR group.

• Authors: Makoto Miyake, Chisato Izumi, Tomohiko Taniguchi, Takeshi Morimoto, Masashi Amano, Shunsuke Nishimura, Takeshi Kitai, Takao Kato, Kazushige Kadota, Kenji Ando, Yutaka Furukawa, Tsukasa Inada, Moriaki Inoko, Katsuhisa Ishii, Genichi Sakaguchi, Fumio Yamazaki, Tadaaki Koyama, Tatsuhiko Komiya, Kazuo Yamanaka, Noboru Nishiwaki, Naoki Kanemitsu, Toshihiko Saga, Tatsuya Ogawa, Shogo Nakayama, Hiroshi Tsuneyoshi, Atsushi Iwakura, Kotaro Shiraga, Michiya Hanyu, Nobuhisa Ohno, Atsushi Fukumoto, Tomoyuki Yamada, Junichiro Nishizawa, Jiro Esaki, Kenji Minatoya, Yoshihisa Nakagawa, Takeshi Kimura, CURRENT AS Registry Investigators
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 82 Issue 10 Pg. 2663-2671 (09 25 2018) ISSN: 1347-4820 [Electronic] Japan
• PMID: 30158400 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Topics

• Aged
• Aortic Valve (surgery)
• Aortic Valve Stenosis (mortality, surgery)
• Female
• Heart Valve Prosthesis Implantation (methods, mortality)
• Humans
• Male
• Middle Aged
• Survival Rate
• Time Factors
• Time-to-Treatment
• Watchful Waiting