Abstract 4787: Half of Patients with Severe Symptomatic Aortic Stenosis Do Not Undergo Aortic Valve Replacement

Although aortic stenosis (AS) is common, little data exist about the rate of aortic valve replacement (AVR) in patients with severe symptomatic AS. Many patients with severe symptomatic AS do not undergo AVR. Echocardiography databases for 3 large tertiary centers were searched for patients in 2005 with severe AS (mean gradient ≥ 40 mmHg, valve area of < 1.0 cm 2 , or overall clinical assessment of severe AS). Records were reviewed for symptoms, referral, surgical AVR, and outcome. Operative risk was calculated using the logistic EuroSCORE. Four hundred thirteen patients had an echocardiogram with severe AS; 44 were excluded based on additional testing or inadequate medical records. Of the remaining 368 patients, 188 (51%) underwent AVR, and 191 (49%) and were un-operated. Of 191 un-operated patients, 126 (66%, 34% of total) had symptoms consistent with AS, 182 (95%) were referred to cardiology, but 75 of 126 (60%) un-operated symptomatic patients were not referred for surgical assessment. Among un-operated symptomatic patients, operative risk was < 5% in 31 (25%) and < 10% in 59 (47%). The prevalence of un-operated patients was similar between institutions. Decisions not to operate most commonly were based on co-morbidities, patient preference, symptoms due to other conditions, and unrecognized AS. With an average follow-up of 13.9 ± 9.8 months, 52 of 191 (27%) un-operated patients died. Half of patients with severe symptomatic AS do not undergo AVR, with similar findings in multiple tertiary care environments. Some patients with severe symptomatic AS may be inappropriately denied access to potentially life-saving therapy.