Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis.

OBJECTIVE: The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients.

DESIGN: A single centre, retrospective cohort study.

PATIENTS AND METHODS: The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity ≥ 4.0 m/s, or mean aortic pressure gradient (MPG) ≥ 40 mm Hg, or an aortic valve area (AVA) <1.0 cm(2)) and 58 patients with very severe AS (a maximal jet velocity ≥ 5.0 m/s, or MPG ≥ 50 mm Hg or an AVA <0.6 cm(2)). Clinical outcomes were compared between the two groups, considering the existence of symptoms.

MAIN OUTCOME MEASURES: All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure.

RESULTS: Mean follow-up was 5.5 ± 3.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p < 0.01; 75% vs 88%, p < 0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p < 0.01 and p < 0.001, respectively).

CONCLUSIONS: Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.