초록접수 현황
| 16F-163 | 구연 발표 |
Impact of Surgical Intervention on Long-term Survival in Patients with Severe Aortic Stenosis
Ho Jin Kim, Hong Rae Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : While the impact of surgical intervention on long-term survival in patients with aortic stenosis (AS) has not been validated in a large-scale cohort study, the prevalence of surgical referral and subsequent aortic valve (AV) replacement (AVR) has been reported suboptimal in real world practices. This study aims to assess the hypothesis that timely surgical intervention is associated with the improved long-term survival in severe AS patients
Methods : We identified 2,363 patients (aged 67±12 years, 1,111 females) diagnosed with severe AS between 2000 and 2015 based on current guidelines (AV area [AVA] ≤ 1.0cm2, peak trans-AV velocity [Vmax] ≥ 4.0m/s or mean AV pressure gradient [PG] ≥ 40mmHg) after excluding infective endocarditis or organic mitral valve disease. Among them, 1,140 patients had very severe AS (AVA ≤ 0.6cm2, Vmax ≥ 5.0m/s or mean PG≥ 60mmHg). Surgical interventions were performed in 1,675 (70.9%) patients promptly at the time of diagnosis (n=1,397) or during follow-up (n=278) either by open surgical AVR (n=1,483) or by TAVR (n=192), while the remainder (n=688) received medical therapy only.
Results : In the intervention group, median time to intervention was 13 days (interquartile range, 7 to 40 days). During follow-up, 310 (18.5%) and 318 (46.2%) patients died in the intervention and the medical therapy group, respectively. On time-varying Cox-hazard models, surgical intervention was associated with a significant risk reduction in overall death (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.38-0.53; P<0.001) after adjusting with significant prognostic factors affecting survival. The improved survival outcomes were demonstrated in a subgroup with very severe AS (HR, 0.34; 95% CI 0.26-0.44; P<0.001) as well as in those with less severe AS (HR, 0.55; 95% CI 0.44-0.70; P<0.001)
Conclusion : As the timely surgical therapy demonstrates marked survival benefits in severe AS patients, further robust measures need to be formulated to increase the recruitment for surgical therapy.
Methods : We identified 2,363 patients (aged 67±12 years, 1,111 females) diagnosed with severe AS between 2000 and 2015 based on current guidelines (AV area [AVA] ≤ 1.0cm2, peak trans-AV velocity [Vmax] ≥ 4.0m/s or mean AV pressure gradient [PG] ≥ 40mmHg) after excluding infective endocarditis or organic mitral valve disease. Among them, 1,140 patients had very severe AS (AVA ≤ 0.6cm2, Vmax ≥ 5.0m/s or mean PG≥ 60mmHg). Surgical interventions were performed in 1,675 (70.9%) patients promptly at the time of diagnosis (n=1,397) or during follow-up (n=278) either by open surgical AVR (n=1,483) or by TAVR (n=192), while the remainder (n=688) received medical therapy only.
Results : In the intervention group, median time to intervention was 13 days (interquartile range, 7 to 40 days). During follow-up, 310 (18.5%) and 318 (46.2%) patients died in the intervention and the medical therapy group, respectively. On time-varying Cox-hazard models, surgical intervention was associated with a significant risk reduction in overall death (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.38-0.53; P<0.001) after adjusting with significant prognostic factors affecting survival. The improved survival outcomes were demonstrated in a subgroup with very severe AS (HR, 0.34; 95% CI 0.26-0.44; P<0.001) as well as in those with less severe AS (HR, 0.55; 95% CI 0.44-0.70; P<0.001)
Conclusion : As the timely surgical therapy demonstrates marked survival benefits in severe AS patients, further robust measures need to be formulated to increase the recruitment for surgical therapy.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Ho Jin Kim, E-mail : rhonin.hojin@gmail.com