Outcome of Patients With Aortic Stenosis Referred to a Multidisciplinary Meeting for Transcatheter Valve

Abstract

Until recently, many elderly patients with symptomatic aortic stenosis and multiple risk factors were untreated due to perceived risks of surgery. With the advent of transcatheter aortic valve implantation there has been a surge in referral for treatment. We present the outcome of patients referred to a multidisciplinary meeting. A total of 175 patients were reviewed between January 2008 and March 2010. Patients' characteristics, investigations, and their outcome designated for transcatheter aortic valve implantation, surgical aortic valve replacement, and medical therapy were studied. The decision making process was a combination of known risk factors accounted for in the European system for cardiac operative risk evaluation and factors unaccounted for in traditional scoring systems. Sixty-three patients underwent transcatheter implantation, 74 underwent surgical valve replacement, and 38 were treated medically. There were no deaths at 30 days in the transcatheter or surgical group. There were more strokes (6.3% vs 1.4%, p = 0.057) and pacemaker implantations (25% vs 0, p = 0.0001) in the transcatheter group compared with the surgical group. The patients in the transcatheter group had shorter ventilation and intensive care stays. Similar numbers were discharged home or to their original residence. At median follow-up of 466 days, more patients had paravalvular and central aortic valve regurgitation in the transcatheter group. At one year there were more deaths in the medically managed group (30%), compared with the transcatheter (17%) or surgical groups (4%). Symptomatic high-risk aortic valve patients have a good outcome after transcatheter aortic valve implantation or surgery. Forty-two percent of patients referred for transcatheter aortic valve implantation had surgery and did well. The medically managed group have a poor outcome.