Survival in high risk patients with severe aortic stenosis: Intervention versus surgery versus medical therapy

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Among high surgical risk patients with severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI), we aimed to analyse the survival outcomes based on the final treatment allocation (specifically, TAVI, surgical aortic valve replacement (AVR), or medical therapy). Between 06/2007 and 08/2009 382 high surgical risk patients were referred for TAVI. Final treatment allocation was based on clinical judgment that took into account frailty, comorbidities, logistic EuroSCORE and anatomical suitability. The mean age and mean logistic EuroSCORE were 81±7 years and 23%±15%, respectively. 241/381 patients (63%) were considered suitable for TAVI. Of those, 12 died on the waiting list (median survival time:15days) and 229 underwent transarterial or transapical TAVI. Among patients who did not undergo TAVI (n=141), 64/141 patients underwent conventional AVR and 77/141 patients received conservative therapy. Survival at one year was significantly better in patients who underwent TAVI (75%) or AVR (73%) than patients receiving medical therapy only (51%, p<0.001, Figure 1). Fig.1 Within a cohort of high surgical risk patients referred for TAVI, medically treated patients had worse 1-year survival outcomes than TAVI or AVR treated patients. The benefit of TAVI and AVR over medical treatment emerged only at 6-month follow-up. There was no significant survival difference between TAVI and SAVR patients.

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