ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Varadarajan, P.
Right arrow Articles by Pai, R. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Varadarajan, P.
Right arrow Articles by Pai, R. G.
Related Collections
Right arrow Valve disease

Ann Thorac Surg 2006;82:2111-2115
© 2006 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Clinical Profile and Natural History of 453 Nonsurgically Managed Patients With Severe Aortic Stenosis

Padmini Varadarajan, MD, Nikhil Kapoor, MD, Ramesh C. Bansal, MD, Ramdas G. Pai, MD*

Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California

Accepted for publication July 6, 2006.

* Address correspondence to Dr Pai, Division of Cardiology, USC/Keck School of Medicine, 1510 San Pablo St, Suite 322, Los Angeles, CA 90033. (Email: rpai{at}usc.edu).

BACKGROUND: Severe aortic stenosis (AS) is a surgically correctable condition. However, aortic valve replacement (AVR) is not offered to many patients with severe AS for various reasons. We investigated the profile and survival patterns of patients with severe AS who did not have AVR.

METHODS: Our echocardiographic database was screened for patients with severe AS, defined as a Doppler estimated aortic valve area of 0.8 cm2 or less between 1993 and 2003. Seven hundred and forty patients with severe AS were identified, of whom 453 patients had no AVR through the follow-up period, forming the study cohort. These patients were comprehensively characterized by obtaining clinical, pharmacologic, and surgical data through a comprehensive chart review and extracting survival data from the National Death Index.

RESULTS: Patient characteristics were as follows: age 75 ± 13 years, 48% male, left ventricular (LV) ejection fraction 52 ± 21%, coronary artery disease in 34%, hypertension in 35%, serum creatinine level greater than 2 mg/dL in 11%, and diabetes mellitus in 14%. The survival at 1 year, 5 years, and 10 years was 62%, 32%, and 18%, respectively. The univariate predictors of reduced survival were advanced age, low LV ejection fraction, heart failure, elevated serum creatinine level, severe mitral regurgitation, and pulmonary hypertension; and the independent predictors were advanced age, low LV ejection fraction, heart failure, elevated serum creatinine level, and systemic hypertension. Concomitant pharmacotherapy had no impact on survival.

CONCLUSIONS: Conservatively treated patients with severe AS have a grave prognosis, and it is worse in the presence of advanced age, LV dysfunction, heart failure, and renal failure.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
E. Manasse
Cooks and recipes
Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 787 - 790.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
P. Schoenhagen, E. M. Tuzcu, S. R. Kapadia, M. Y. Desai, and L. G. Svensson
Three-dimensional imaging of the aortic valve and aortic root with computed tomography: new standards in an era of transcatheter valve repair/implantation
Eur. Heart J., September 1, 2009; 30(17): 2079 - 2086.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
J. Leipsic, D. Wood, D. Manders, F. Nietlispach, J. B. Masson, J. Mayo, S. Al-Bugami, and J. G. Webb
The Evolving Role of MDCT in Transcatheter Aortic Valve Replacement: A Radiologists' Perspective
Am. J. Roentgenol., September 1, 2009; 193(3): W214 - W219.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. S. Bach, M. Awais, H. S. Gurm, and S. Kohnstamm
Failure of guideline adherence for intervention in patients with severe mitral regurgitation.
J. Am. Coll. Cardiol., August 25, 2009; 54(9): 860 - 865.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
N. Al-Attar, W. Ghodbane, D. Himbert, C. Rau, R. Raffoul, D. Messika-Zeitoun, E. Brochet, A. Vahanian, and P. Nataf
Unexpected complications of transapical aortic valve implantation.
Ann. Thorac. Surg., July 1, 2009; 88(1): 90 - 94.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. R. Kapadia, S. S. Goel, L. Svensson, E. Roselli, R. M. Savage, L. Wallace, S. Sola, P. Schoenhagen, M. H. Shishehbor, R. Christofferson, et al.
Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement.
J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1430 - 1435.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. Zajarias and A. G. Cribier
Outcomes and Safety of Percutaneous Aortic Valve Replacement
J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1829 - 1836.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Leontyev, T. Walther, M. A. Borger, S. Lehmann, A. K. Funkat, A. Rastan, J. Kempfert, V. Falk, and F. W. Mohr
Aortic valve replacement in octogenarians: utility of risk stratification with EuroSCORE.
Ann. Thorac. Surg., May 1, 2009; 87(5): 1440 - 1445.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. Zingone, G. Gatti, E. Rauber, P. Tiziani, L. Dreas, A. Pappalardo, B. Benussi, and A. Spina
Early and Late Outcomes of Cardiac Surgery in Octogenarians
Ann. Thorac. Surg., January 1, 2009; 87(1): 71 - 78.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. G. Pai, P. Varadarajan, and A. Razzouk
Survival Benefit of Aortic Valve Replacement in Patients With Severe Aortic Stenosis With Low Ejection Fraction And Low Gradient With Normal Ejection Fraction
Ann. Thorac. Surg., December 1, 2008; 86(6): 1781 - 1789.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
E. Grube, L. Buellesfeld, R. Mueller, B. Sauren, B. Zickmann, D. Nair, H. Beucher, T. Felderhoff, S. Iversen, and U. Gerckens
Progress and Current Status of Percutaneous Aortic Valve Replacement: Results of Three Device Generations of the CoreValve Revalving System
Circ Cardiovasc Interv, December 1, 2008; 1(3): 167 - 175.
[Abstract] [Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
L. G. SVENSSON
Evolution and results of aortic valve surgery, and a 'disruptive' technology
Cleveland Clinic Journal of Medicine, November 1, 2008; 75(11): 802 - 804.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. M. Dewey, D. L. Brown, T. S. Das, W. H. Ryan, J. E. Fowler, S. D. Hoffman, S. L. Prince, M. A. Herbert, D. Culica, and M. J. Mack
High-Risk Patients Referred for Transcatheter Aortic Valve Implantation: Management and Outcomes
Ann. Thorac. Surg., November 1, 2008; 86(5): 1450 - 1457.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J. S. Gammie, L. S. Krowsoski, J. M. Brown, P. N. Odonkor, C. A. Young, M. J. Santos, J. S. Gottdiener, and B. P. Griffith
Aortic Valve Bypass Surgery: Midterm Clinical Outcomes in a High-Risk Aortic Stenosis Population
Circulation, September 30, 2008; 118(14): 1460 - 1466.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. G. Svensson, T. Dewey, S. Kapadia, E. E. Roselli, A. Stewart, M. Williams, W. N. Anderson, D. Brown, M. Leon, B. Lytle, et al.
United States Feasibility Study of Transcatheter Insertion of a Stented Aortic Valve by the Left Ventricular Apex
Ann. Thorac. Surg., July 1, 2008; 86(1): 46 - 55.
[Abstract] [Full Text] [PDF]

Home page
 MMCTSHome page
F. Maisano, I. Michev, P. Denti, O. Alfieri, and A. Colombo
Transfemoral transcatheter aortic valve implantation using the balloon expandable SAPIEN transcatheter heart valve device
MMCTS, June 26, 2008; 2008(0626): 3087.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
T. Walther, V. Falk, J. Kempfert, M. A. Borger, J. Fassl, M. W.A. Chu, G. Schuler, and F. W. Mohr
Transapical minimally invasive aortic valve implantation; the initial 50 patients
Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 983 - 988.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
T. K. Rosengart, T. Feldman, M. A. Borger, T. A. Vassiliades Jr, A. M. Gillinov, K. J. Hoercher, A. Vahanian, R. O. Bonow, and W. O'Neill
Percutaneous and Minimally Invasive Valve Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group
Circulation, April 1, 2008; 117(13): 1750 - 1767.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. M. Dewey, D. Brown, W. H. Ryan, M. A. Herbert, S. L. Prince, and M. J. Mack
Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement
J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 180 - 187.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
T. Feldman and M. B. Leon
Prospects for Percutaneous Valve Therapies
Circulation, December 11, 2007; 116(24): 2866 - 2877.
[Full Text] [PDF]

Home page
 CirculationHome page
J. G. Webb, S. Pasupati, K. Humphries, C. Thompson, L. Altwegg, R. Moss, A. Sinhal, R. G. Carere, B. Munt, D. Ricci, et al.
Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis
Circulation, August 14, 2007; 116(7): 755 - 763.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. G. Pai, P. Varadarajan, N. Kapoor, and R. C. Bansal
Aortic Valve Replacement Improves Survival in Severe Aortic Stenosis Associated With Severe Pulmonary Hypertension
Ann. Thorac. Surg., July 1, 2007; 84(1): 80 - 85.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Large
Invited commentary
Ann. Thorac. Surg., December 1, 2006; 82(6): 2115 - 2115.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.