TCT-832 Epidemiology of Severe Aortic Stenosis in the Elderly: A Systematic Review and Meta-Analysis of Published Prevalence Estimates

Abstract

Background:The prevalence of degenerative Aortic Stenosis (AS) is strongly linked to the phenomenon of population aging. While elderly patients form the majority of patients treated with AS, comorbidities place them at high for surgical aortic valve replacement (SAVR). With the new treatment option of transcatheter aortic valve implantation (TAVI), also patients formerly deemed inoperable can now be treated. Robust estimates in an elderly population remain unclear. The objective of this study is to perform a systematic review (SR) and meta-analysis (MA) to identify observational populationbased studies that report prevalence of severe AS in persons Ͼ 70yrs. Methods: A search of the published literature was conducted in Feb 2012 using Medical databases. General population observational studies, surveys, registries that reported the prevalence of degenerative severe AS in elderly persons (Ͼ70yrs) were included. Although the methods used to diagnose severe AS differed slightly between studies, the cut-off diagnostic criteria used in this analysis, where severe AS is defined as aortic valve area Ͻ1 cm 2 , was taken from the ESC AS guidelines. A MA of prevalence estimates was conducted in order to provide a point estimate (with confidence interval) of severe AS prevalence. Heterogeneity was quantified using the I2 measure and its significance was tested with the Q test. Results: A total of 1524 citations were retrieved for review and 7 observational studies reported severe AS in an elderly population. Five studies reported severe AS separately (from other forms of AS) and were included in the MA. The pooled prevalence of severe AS in persons Ͼ75yrs was 4.3% (95% CI 3.1%, 5.5%; heterogeneity, I2ϭ52.8%, chi-square p-valueϭ0.095). In persons Ͼ80yrs the pooled prevalence of severe AS was 4.8% (95% CI 3.4%, 6.3%; heterogeneity, I2ϭ48.2%, chi-square p-valueϭ0.122). Due to the moderate amount of heterogeneity in the estimates, which was deemed statistically non-significant, a fixed-effect approach was used. Conclusions: Our unique SR shows a prevalence of almost 5% in the octogenarians have severe AS. These figures reconfirm AS as a major disease and form a starting point in light of new less invasive TAV implantation.

Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A Systematic Review

“…A systematic review by Strachan and colleagues [1] found that 4.3% of persons aged over 75 met the criterion of severe AS of having an aortic valve area (AVA) less than 1 cm. Surgical aortic valve replacement has been used for decades as the gold standard treatment for AS [2].…”