TY - JOUR AU - Vollenbroich, René AU - Sakiri, Elmaze AU - Roost, Eva AU - Stortecky, Stefan AU - Rothenbühler, Martina AU - Räber, Lorenz AU - Englberger, Lars AU - Wenaweser, Peter AU - Carrel, Thierry AU - Windecker, Stephan AU - Pilgrim, Thomas PY - 2019/02/24 Y2 - 2024/03/28 TI - Clinical outcomes in high-risk patients with a severe aortic stenosis: a seven-year follow-up analysis JF - Swiss Medical Weekly JA - Swiss Med Wkly VL - 149 IS - 0708 SE - Original article DO - 10.4414/smw.2019.20013 UR - https://smw.ch/index.php/smw/article/view/2576 SP - w20013 AB - <p><strong>INTRODUCTION</strong> <p>The aim of this study was to assess the clinical outcomes of high-risk patients with severe aortic stenosis (AS) allocated to medical treatment (MT), transcatheter aortic valve replacement (TAVR), and surgical aortic valve replacement (SAVR) through extended follow-up.</p> <strong>METHODS AND RESULTS</strong> <p>Consecutive patients with severe symptomatic AS included in a prospective single centre registry underwent sweep follow-up between March and August 2016. Clinical outcomes were assessed using a competing risk model. A total of 442 patients (median age 83 years; 52% female) were allocated to MT (n = 78), SAVR (n = 107), or TAVR (n = 257) with a gradient of surgical risk as assessed by logistic EuroSCORE (MT: 27.9 ± 14.5%, TAVR: 24.7 ± 24.9%, SAVR: 12.5 ± 8.2%; p &lt;0.001). Survival after a median duration of follow-up of seven years was 6.4% (MT), 30.4% (TAVR), and 46.7% (SAVR), respectively (p &lt;0.001). One TAVR and one SAVR patient underwent repeat intervention for valvular degeneration between 4.5 and 8.4 years after intervention. Compromised left ventricular function (LVEF &lt;40%) was associated with increased mortality (HR 1.62, 95% CI 1.22–2.15; p &lt;0.0001), whereas female sex was protective (HR 0.68, 95% CI 0.53–0.88; p = 0.0006).</p> <strong>CONCLUSION</strong> <p>Both TAVR and SAVR reduced mortality compared to MT throughout a median duration of follow-up of seven years. Repeat interventions for valvular degeneration were rare.</p></p> ER -