Morbidity, mortality and quality of life in patients with non-operable aortic stenosis

Abstract

Degenerative calcific aortic stenosis has a poor prognosis if left untreated. New procedures such as trans-catheter aortic valve implantation and the apico-aortic valved conduit have been introduced for patients not fit for surgical replacement of the valve. Despite initial encouraging results with these modalities a group of patients are still being denied treatment due to old age and severe co-morbidity. The aims of this study were to explore the morbidity, mortality and quality of life of these patients. We included all patients with aortic stenosis referred to Rigshospitalet, Denmark in 2010. Data regarding demographics and co-morbidity were collected retrospectively, and all patients alive at follow-up received a questionnaire to estimate their quality of life. Morbidity, mortality and quality of life were compared with a group of symptomatic patients in whom there was not yet indication to replace the valve. Out of 268 patients with aortic stenosis 35 patients were deemed unfit for intervention and in 19 patients there was no indication to replace the valve. Patients not eligible for intervention had a higher mortality (p = 0.002), and a lower quality of life (p < 0.01). Patients with aortic stenosis who are deemed unfit for intervention have a high mortality and a low quality of life. These findings indicate that intervention should be considered even in old patients with severe co-morbidity. Data collection was approved by the Danish Data Protection Agency.