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

Published on Jun 1, 2014in Journal of Internal Medicine6.05
· DOI :10.1111/joim.12174
Manuel Martínez-Sellés21
Estimated H-index: 21
(UEM: European University of Madrid),
J. J. Gómez Doblas1
Estimated H-index: 1
+ 12 AuthorsRamón López-Palop22
Estimated H-index: 22
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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.
  • References (47)
  • Citations (28)
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References47
Newest
Published on Feb 1, 2014in European Geriatric Medicine1.23
Andreas W. Schoenenberger19
Estimated H-index: 19
(University of Bern),
N Werner1
Estimated H-index: 1
+ 7 AuthorsAndrea Ungar29
Estimated H-index: 29
(UniFI: University of Florence)
Abstract Purpose Aortic stenosis (AS) is the most common valvular abnormality in the elderly population. For inoperable patients or those at high-risk for surgery, transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option. The aim of the “Comprehensive geriatric assessment for transcatheter aortic valve implantation” (CGA-TAVI) registry is to evaluate the effectiveness of TAVI from the perspective of the geriatrician and to identify patient characteristics and i...
Published on Jun 1, 2013in European Geriatric Medicine1.23
Andrea Ungar29
Estimated H-index: 29
(UniFI: University of Florence),
Peter Bramlage35
Estimated H-index: 35
+ 2 AuthorsJ.-P. Michel1
Estimated H-index: 1
Abstract Aortic stenosis (AS) represents a significant healthcare burden in the elderly population. For inoperable patients or those at high-risk for surgery, transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option. The recently conducted European Union Geriatric Medicine Society (EUGMS) TAVI survey found that the involvement of geriatricians in the management of patients undergoing TAVI is generally low. Because of the complexity and rapidly progressive natur...
Published on Mar 1, 2013in European Heart Journal23.24
Andreas W. Schoenenberger19
Estimated H-index: 19
(University of Bern),
Stefan Stortecky32
Estimated H-index: 32
(University of Bern)
+ 10 AuthorsChrista-Maria Schoenenberger2
Estimated H-index: 2
(University of Bern)
Aims This study aimed to assess functional course in elderly patients undergoing transcatheter aortic valve implantation (TAVI) and to find predictors of functional decline. Methods and results In this prospective cohort, functional course was assessed in patients ≥70 years using basic activities of daily living (BADL) before and 6 months after TAVI. Baseline EuroSCORE, STS score, and a frailty index (based on assessment of cognition, mobility, nutrition, instrumental and basic activities of dai...
Published on Oct 1, 2012in European Heart Journal23.24
Alec Vahanian88
Estimated H-index: 88
(University of Paris),
Ottavio Alfieri Fects69
Estimated H-index: 69
(UniSR: Vita-Salute San Raffaele University)
+ 63 AuthorsThomas Walther77
Estimated H-index: 77
ACE : angiotensin-converting enzyme AF : atrial fibrillation aPTT : activated partial thromboplastin time AR : aortic regurgitation ARB : angiotensin receptor blockers AS : aortic stenosis AVR : aortic valve replacement BNP : B-type natriuretic peptide BSA : body surface area CABG : coronary artery bypass grafting CAD : coronary artery disease CMR : cardiac magnetic resonance CPG : Committee for Practice Guidelines CRT : cardiac resynchronization therapy CT : computed tomography EACTS : European...
Mary Ann Clark7
Estimated H-index: 7
,
Suzanne V. Arnold30
Estimated H-index: 30
(UMKC: University of Missouri–Kansas City)
+ 6 AuthorsDavid J. Cohen105
Estimated H-index: 105
(UMKC: University of Missouri–Kansas City)
Background—Patients with severe, symptomatic aortic stenosis, who do not undergo valve replacement surgery have a poor long-term prognosis. Limited data exist on the medical resource utilization and costs during the final stages of the disease. Methods and Results—We used data from the 2003 Medicare 5% standard analytic files to identify patients with aortic stenosis and a recent hospitalization for heart failure, who did not undergo valve replacement surgery within the ensuing 2 calendar quarte...
Published on Jul 31, 2012in BMJ27.60
Hans Van Brabandt12
Estimated H-index: 12
,
Mattias Neyt17
Estimated H-index: 17
,
Frank Hulstaert22
Estimated H-index: 22
Many of the 40 000 transcatheter procedures so far carried out cannot be justified on medical or cost effectiveness grounds. Hans Van Brabandt , Mattias Neyt , and Frank Hulstaert examine why practice has gone beyond the evidence
Published on May 3, 2012in The New England Journal of Medicine70.67
Raj Makkar56
Estimated H-index: 56
,
Gregory P. Fontana26
Estimated H-index: 26
+ 22 AuthorsHoward C. Herrmann71
Estimated H-index: 71
BackgroundTranscatheter aortic-valve replacement (TAVR) is the recommended therapy for patients with severe aortic stenosis who are not suitable candidates for surgery. The outcomes beyond 1 year in such patients are not known. MethodsWe randomly assigned patients to transfemoral TAVR or to standard therapy (which often included balloon aortic valvuloplasty). Data on 2-year outcomes were analyzed. ResultsA total of 358 patients underwent randomization at 21 centers. The rates of death at 2 years...
Published on May 3, 2012in The New England Journal of Medicine70.67
Susheel Kodali59
Estimated H-index: 59
(Columbia University),
Mathew R. Williams50
Estimated H-index: 50
(Columbia University)
+ 22 AuthorsAugusto D. Pichard89
Estimated H-index: 89
(MedStar Washington Hospital Center)
The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P = 0.41) and at 2 years (Kaplan–Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P = 0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P = 0.52). At 30 days, strokes were more frequent with TAVR than with surgical replac...
Published on May 1, 2012in Journal of the American Geriatrics Society4.11
Chad Boult87
Estimated H-index: 87
(UMN: University of Minnesota),
Tatyana Shamliyan33
Estimated H-index: 33
(UMN: University of Minnesota)
+ 1 AuthorsJames T Pacala20
Estimated H-index: 20
(UMN: University of Minnesota)
Objectives To ascertain the effect on survival of eight common geriatric syndromes (multiple comorbidities, cognitive impairment, frailty, disability, sarcopenia, malnutrition, homeostenosis, and chronic inflammation), identified by an expert panel of academic geriatricians. Design A systematic literature review sought studies from a variety of sources to compare survival and life expectancy of individuals with geriatric syndromes with those of the general population. Setting Studies used reflec...
Cited By28
Newest
Published on Feb 13, 2019in Scientific Reports4.01
Kazuya Nagao15
Estimated H-index: 15
,
Tomohiko Taniguchi7
Estimated H-index: 7
(Kyoto University)
+ 35 AuthorsChisato Izumi17
Estimated H-index: 17
(Tenri Hospital)
Prognostic impact of anemia complicating severe aortic stenosis (AS) remains unclear. We assessed the impact of anemia on cardiovascular and bleeding outcomes in 3403 patients enrolled in the CURRENT AS registry. 835 patients (25%) had mild (hemoglobin 11.0–12.9 g/dl for men/11.0–11.9 g/dl for women) and 1282 patients (38%) had moderate/severe anemia (Hb ≤ 10.9 g/dl) at diagnosis of severe AS. Mild and moderate/severe anemia were associated with significantly increased risks relative to no anemi...
Published on May 1, 2019in Revista Espanola De Cardiologia5.13
Hugo González Saldivar1
Estimated H-index: 1
,
Lourdes Vicent Alaminos1
Estimated H-index: 1
+ 18 AuthorsGabriela Guzmán-Martínez5
Estimated H-index: 5
(Hospital Universitario La Paz)
Abstract Introduction and objectives Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months. Methods Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Dia...
Published on May 1, 2019in Revista Espanola De Cardiologia5.13
Hugo González Saldivar1
Estimated H-index: 1
,
Lourdes Vicent Alaminos1
Estimated H-index: 1
+ 18 AuthorsGabriela Guzmán-Martínez5
Estimated H-index: 5
(Hospital Universitario La Paz)
Resumen Introduccion y objetivos Los tratamientos actuales de la estenosis aortica (EAo) grave incluyen el implante percutaneo de valvula aortica (TAVI) y la cirugia de sustitucion valvular aortica (SVAo). El objetivo es describir la evolucion de los pacientes con EAo grave tras la indicacion de intervencion, las variables que influyen en su pronostico y los determinantes de un tiempo de espera superior a 2 meses. Metodos Subanalisis del registro IDEAS (Influencia del Diagnostico de Estenosis Ao...
Published on Sep 1, 2018in European Journal of Internal Medicine3.66
Juan José Gómez Doblas20
Estimated H-index: 20
(UMA: University of Málaga),
Miguel A. López-Garrido3
Estimated H-index: 3
(UMA: University of Málaga)
+ 5 AuthorsManuel Martínez-Sellés21
Estimated H-index: 21
(Complutense University of Madrid)
Abstract Introduction The coexistence of significant mitral regurgitation (MR) and severe aortic stenosis is prevalent, has a prognostic impact and makes treatment in the elderly population a complex issue. The aim of this study is to determine the prevalence of significant MR among a population of octogenarians and its influence on treatment and prognosis. Methods We used the data from PEGASO (Pronostico de la Estenosis Grave Aortica Sintomatica del Octogenario), a prospective registry that con...
Published on Feb 1, 2018in Heart Lung and Circulation2.08
Eva Bernal3
Estimated H-index: 3
(Autonomous University of Barcelona),
Albert Ariza-Solé11
Estimated H-index: 11
+ 5 AuthorsManuel Martínez-Sellés21
Estimated H-index: 21
(Complutense University of Madrid)
Background The number of nonagenarian patients with aortic stenosis will likely increase due to the ageing population. We assessed the clinical characteristics, management, and outcomes of nonagenarian patients with severe aortic stenosis. Methods A total of 177 (117 females and 60 males) consecutive nonagenarian patients from two large contemporary registries were included in this study. Clinical characteristics, comorbidity as assessed by the Charlson Index, clinical management, and outcomes w...
Published on Jun 1, 2017in Journal of Cardiology2.29
Eva Bernal3
Estimated H-index: 3
(Autonomous University of Barcelona),
Albert Ariza-Solé11
Estimated H-index: 11
+ 7 AuthorsManuel Martínez-Sellés21
Estimated H-index: 21
(Complutense University of Madrid)
Abstract Background Despite current recommendations, a high percentage of patients with severe symptomatic aortic stenosis are managed conservatively. The aim of this study was to study symptomatic patients undergoing conservative management from the IDEAS registry, describing their baseline clinical characteristics, mortality, and the causes according to the reason for conservative management. Methods Consecutive patients with severe aortic stenosis diagnosed at 48 centers during January 2014 w...
Manuel Martínez-Sellés21
Estimated H-index: 21
(Complutense University of Madrid),
Albert Ariza-Solé11
Estimated H-index: 11
+ 1 AuthorsFrancesc Formiga25
Estimated H-index: 25
Published on Apr 1, 2017in European Geriatric Medicine1.23
V. Collas4
Estimated H-index: 4
(University of Antwerp),
Bernard P. Paelinck6
Estimated H-index: 6
+ 4 AuthorsJohan Bosmans32
Estimated H-index: 32
(University of Antwerp)
Abstract Objectives The aim of this study was to evaluate which components of the multidimensional geriatric assessment mostly match to the subjective multidisciplinary heart team decision in order to objectify the treatment selection of elderly patients with symptomatic severe aortic valve stenosis (AVS). Methods One hundred and thirteen elderly patients with severe, symptomatic AVS underwent standardized multidimensional geriatric assessment, independent of the clinical multidisciplinary heart...
Published on Feb 1, 2017in Expert Review of Medical Devices2.21
Marco Barbanti46
Estimated H-index: 46
(University of Catania),
Simona Gulino13
Estimated H-index: 13
(University of Catania)
+ 1 AuthorsCorrado Tamburino55
Estimated H-index: 55
(University of Catania)
ABSTRACTIntroduction: Over the past decade, transcatheter aortic valve implantation (TAVI) has evolved rapidly toward an extremely reproducible, safe and effective procedure, with a marked reduction of its related complications. However, the occurrence of conduction disturbances and the need for permanent pacemaker implantation (PPI) after TAVI remains a concern.Areas covered: In this article review, we will go through the mechanisms involved in conduction disturbances after TAVI, and we will di...
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