Foregoing AVR in asymptomatic aortic stenosis may compromise survival

When advised against aortic valve replacement (AVR), patients with asymptomatic severe aortic stenosis show higher rates of mortality, a recent study has found.

This retrospective cohort study included 2,341 patients whose medical records were accessed to determine disease characteristics and treatment strategy. Overall, 1,953 patients were referred for AVR, while the rest were given conservative treatment. In particular, 144 patients were advised against undergoing the procedure due to lack of symptoms.

Over a mean follow-up of 5.4 years, 1,126 patients died, yielding a mortality rate of 48 percent. Notably, 73 of the 114 asymptomatic patients died (64 percent). Survival rates at 1, 2, and 5 years for asymptomatic participants were 88 percent, 75 percent, and 39 percent, respectively, as opposed to 91 percent, 87 percent, and 74 percent, respectively, among those who underwent AVR.

Age ang sex matching slightly attenuated the differences in 1-, 2-, and 5-year survival rates between asymptomatic and AVR patients, but the effect remained statistically significant (log-rank p<0.001).

Of the 73 asymptomatic deaths, causes were available for 70. Majority (44 percent; n=31) of these mortalities were due to cardiovascular reasons (n=31). Malignancies, strokes, and kidney diseases were other relatively common causes of death in the asymptomatic patients.

“The optimal management strategy for asymptomatic patients with severe aortic stenosis remains unclear. In our retrospective study, patients who were advised against surgery at our tertiary care hospital due to a perceived lack of symptoms had significantly higher mortality than patients referred for AVR,” the researchers said.