Makoto Miyake1, Chisato Izumi1, Tomohiko Taniguchi2, Takeshi Morimoto3, Masashi Amano1, Shunsuke Nishimura1, Takeshi Kitai4, Takao Kato2, Kazushige Kadota5, Kenji Ando6, Yutaka Furukawa4, Tsukasa Inada7, Moriaki Inoko8, Katsuhisa Ishii9, Genichi Sakaguchi10, Fumio Yamazaki11, Tadaaki Koyama12, Tatsuhiko Komiya13, Kazuo Yamanaka14, Noboru Nishiwaki15, Naoki Kanemitsu16, Toshihiko Saga17, Tatsuya Ogawa18, Shogo Nakayama19, Hiroshi Tsuneyoshi20, Atsushi Iwakura21, Kotaro Shiraga22, Michiya Hanyu23, Nobuhisa Ohno24, Atsushi Fukumoto25, Tomoyuki Yamada26, Junichiro Nishizawa27, Jiro Esaki28, Kenji Minatoya29, Yoshihisa Nakagawa1, Takeshi Kimura2. 1. Department of Cardiology, Tenri Hospital. 2. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine. 3. Department of Clinical Epidemiology, Hyogo College of Medicine. 4. Department of Cardiology, Kobe City Medical Center General Hospital. 5. Department of Cardiology, Kurashiki Central Hospital. 6. Department of Cardiology, Kokura Memorial Hospital. 7. Department of Cardiovascular Center, Osaka Red Cross Hospital. 8. Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 9. Department of Cardiology, Kansai Electric Power Hospital. 10. Department of Cardiovascular Surgery, Kokura Memorial Hospital. 11. Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital. 12. Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital. 13. Department of Cardiovascular Surgery, Kurashiki Central Hospital. 14. Department of Cardiovascular Surgery, Tenri Hospital. 15. Department of Cardiovascular Surgery, Kindai University Nara Hospital. 16. Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital. 17. Department of Cardiovascular Surgery, Kindai University Hospital. 18. Department of Cardiovascular Surgery, Kishiwada City Hospital. 19. Department of Cardiovascular Surgery, Osaka Red Cross Hospital. 20. Department of Cardiovascular Surgery, Shizuoka General Hospital. 21. Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center. 22. Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center. 23. Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 24. Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center. 25. Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital. 26. Department of Cardiovascular Surgery, Shiga Medical Center for Adults. 27. Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital. 28. Department of Cardiovascular Surgery, Japanese Red Cross Otsu Hospital. 29. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine.
Abstract
BACKGROUND: There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management. Methods and Results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS. Of 1,808 asymptomatic patients, 286 patients initially underwent AVR (initial AVR group), and 377 patients were initially managed conservatively and eventually underwent AVR (AVR after watchful waiting group). Mortality after AVR was compared between the 2 groups. Subgroup analysis according to peak aortic jet velocity (Vmax) at diagnosis was also conducted. There was no significant difference between the 2 groups in 5-year overall survival (OS; 86.0% vs. 84.1%, P=0.34) or cardiovascular death-free survival (DFS; 91.3% vs. 91.1%, P=0.61), but on subgroup analysis of patients with Vmax ≥4.5 m/s at diagnosis, the initial AVR group was superior to the AVR after watchful waiting group in both 5-year OS (88.4% vs. 70.6%, P=0.003) and cardiovascular DFS (91.9% vs. 81.7%, P=0.023). CONCLUSIONS: Asymptomatic severe AS patients who underwent AVR after watchful waiting had a postoperative survival rate similar to those who initially underwent AVR. In a subgroup of patients with Vmax ≥4.5 m/s at diagnosis, however, the AVR after watchful waiting group had worse postoperative survival rate than the initial AVR group.
BACKGROUND: There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management. Methods and Results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS. Of 1,808 asymptomatic patients, 286 patients initially underwent AVR (initial AVR group), and 377 patients were initially managed conservatively and eventually underwent AVR (AVR after watchful waiting group). Mortality after AVR was compared between the 2 groups. Subgroup analysis according to peak aortic jet velocity (Vmax) at diagnosis was also conducted. There was no significant difference between the 2 groups in 5-year overall survival (OS; 86.0% vs. 84.1%, P=0.34) or cardiovascular death-free survival (DFS; 91.3% vs. 91.1%, P=0.61), but on subgroup analysis of patients with Vmax ≥4.5 m/s at diagnosis, the initial AVR group was superior to the AVR after watchful waiting group in both 5-year OS (88.4% vs. 70.6%, P=0.003) and cardiovascular DFS (91.9% vs. 81.7%, P=0.023). CONCLUSIONS: Asymptomatic severe AS patients who underwent AVR after watchful waiting had a postoperative survival rate similar to those who initially underwent AVR. In a subgroup of patients with Vmax ≥4.5 m/s at diagnosis, however, the AVR after watchful waiting group had worse postoperative survival rate than the initial AVR group.