Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention

Abstract

Objective: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).

Study design: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index.

Setting: Transnational registry in Spain.

Subjects: We included 928 patients aged ≥80 years with severe symptomatic AS.

Interventions: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy.

Main outcome measures: All-cause death.

Results: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002).

Conclusion: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.

Keywords: ageing; aortic stenosis; aortic surgery.