Management of Aortic Stenosis: Wellington Hospital Population

Abstract

Background: Relevant aortic valvestenosis (AS) is associated with adverse prognosis. With TAVI emerging, the presented study audited management of relevant AS in Wellington. Methods: 79 patients with aortic stenosis were prospectively enrolled from February 2015-2016. Inclusion criteria were echo features demonstrating stage C or D stenosis according to ACC/AHA guidelines. Treatment outcomes included surgical valve replacement (AVR), Transcatheter Aortic Valve Replacement (TAVI), Balloon Valvuloplasty (BAV) and Medical Management. Results: 63/79 had AS indicating treatment (C2 or D). Mean age was 75.8AE10 and 37 were males. Mean followup was 193 days. In this group completed or planned treatments were: AVR 31 (49%), TAVI 4 (6.3%) and BAV 4 (6.3%). 9 (14.3%) were for medical management, the remainder were under review. There were 6 deaths: 2 post-surgery, 2 in the medical group, 2 in the review group. STS mortality scores differed between surgical and medically treated patients (1.9 AE1.5% vs 4.3AE2.7%, p<0.05). EUROSCORE was lower in surgical compared to medical groups (6.1AE1.9% vs 9.2 AE2.8%, p<0.01). Surgical patients were significantly younger compared to other groups (69.6AE8.4, p<0.05). TAVI patients were on average 15.5 years older than surgical patients (p<0.05) with a 3% higher mortality (NS). Conclusion: In this cohort 55.6% of patients with symptomatic aortic stenosis received or had planned treatment. Those for medical management were older and had higher STS and EUROSCOREs. There were a significant proportion of patients under ongoing review. TAVI patients were profoundly older and made up 6.3% of patients with indication for intervention.