Characteristics of Inoperable Patients with Severe Aortic Valve Stenosis —In the Era of Transcatheter Aortic Valve Replacement

Tatsuya Seki; Mamoru Sakakibara; Yasushige Shingu; Hiroki Katoh; Satoru Wakasa; Hiroyuki Tsutsui; Yoshiro Matsui

doi:10.5761/atcs.oa.14-00126

Original Articles

Characteristics of Inoperable Patients with Severe Aortic Valve Stenosis —In the Era of Transcatheter Aortic Valve Replacement

Tatsuya Seki, Mamoru Sakakibara, Yasushige Shingu, Hiroki Katoh, Satoru Wakasa, Hiroyuki Tsutsui, Yoshiro Matsui

Author information

Tatsuya Seki
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
Mamoru Sakakibara
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
Yasushige Shingu
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
Hiroki Katoh
Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
Satoru Wakasa
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
Hiroyuki Tsutsui
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
Yoshiro Matsui
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan

Keywords: aortic valvular stenosis, aortic valve replacement, transcatheter aortic valve replacement, inoperable AS, frailty

JOURNAL FREE ACCESS

2015 Volume 21 Issue 2 Pages 132-138

DOI https://doi.org/10.5761/atcs.oa.14-00126

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Abstract

Purpose: Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic option for severe aortic valvular stenosis (AS). To determine the indication for TAVR, it is mandatory to clarify the characteristics of the patients who were judged as inoperable for conventional aortic valve replacement (cAVR).Methods: Of 185 patients newly diagnosed as severe AS from March 2010 to April 2011, we studied the characteristics of 61 (33%) patients (mean age, 86 ± 8 years) who were judged as inoperable.Results: Younger patients (<85 years old, n = 22) had more major comorbidities and lower left ventricular ejection fraction than older patients (≥85 years old, n = 39). Mean estimated mortality for cAVR by Japan score was 7.0% ± 7.4%. Japan score did not correlate to age and was calculated relatively low in the older age group (6.2% ± 7.0%) than the younger age group (8.3% ± 8.1%).Conclusion: One thirds of severe AS patients were judged as inoperable. In advanced age patients, age itself and other factors, which are not included in the conventional scoring systems, might have contributed to the decision making not to perform cAVR by cardiologists. Further study is necessary to define risk factors except for age.

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