%0 Journal Article
%A Martínez-Sellés, M
%A Gómez Doblas, J J
%A Carro Hevia, A
%A García de la Villa, B
%A Ferreira-González, I
%A Alonso Tello, A
%A Andión Ogando, R
%A Ripoll Vera, T
%A Arribas Jiménez, A
%A Carrillo, P
%A Rodríguez Pascual, C
%A Casares i Romeva, M
%A Borras, X
%A Cornide, L
%A López-Palop, R
%T Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.
%D 2014
%@ 0954-6820
%U http://hdl.handle.net/10668/2027
%X OBJECTIVETo study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS).STUDY DESIGNProspective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index.SETTINGTransnational registry in Spain.SUBJECTSWe included 928 patients aged ≥80 years with severe symptomatic AS.INTERVENTIONSAortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy.MAIN OUTCOME MEASURESAll-cause death.RESULTSMean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002).CONCLUSIONOctogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
%K Ageing
%K Aortic stenosis
%K Aortic surgery
%K Anciano de 80 o más años
%K Estenosis de la válvula aórtica
%K Implantación de prótesis de válvulas cardíacas
%K Cateterismo cardíaco
%K Causas de muerte
%K Pronóstico
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