Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Valvular Heart Disease
Reasons for Choosing Conservative Management in Symptomatic Patients With Severe Aortic Stenosis ― Observations From the CURRENT AS Registry ―
Mitsuru IshiiTomohiko TaniguchiTakeshi MorimotoHisashi OgawaNobutoyo MasunagaMitsuru AbeYusuke YoshikawaHiroki ShiomiKenji AndoNorio KanamoriKoichiro MurataTakeshi KitaiYuichi KawaseChisato IzumiMakoto MiyakeHirokazu MitsuokaMasashi KatoYutaka HiranoShintaro MatsudaKazuya NagaoTsukasa InadaHiroshi MabuchiYasuyo TakeuchiKeiichiro YamaneMamoru ToyofukuEri Minamino-MutaTakao KatoMoriaki InokoTomoyuki IkedaAkihiro KomasaKatsuhisa IshiiKozo HottaNobuya HigashitaniYoshihiro KatoYasutaka InuzukaToshikazu JinnaiYuko MorikamiMasaharu AkaoKenji MinatoyaTakeshi Kimuraon behalf of the CURRENT AS Registry Investigators
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2019 Volume 83 Issue 9 Pages 1944-1953

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Abstract

Background:There has not been a previous report on the long-term outcomes of those patients who refuse aortic valve replacement (AVR) despite physicians’ recommendations.

Methods and Results:Among 3,815 consecutive patients with severe aortic stenosis (AS) enrolled in the CURRENT AS registry, the study population comprised 2,005 symptomatic patients, who were subdivided into 3 groups by their treatment strategy and the reasons for conservative strategy (Initial AVR group: n=905; Patient rejection group: n=256; Physician judgment group, n=844). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalization. Patients in the patient rejection group as compared with those in the physician judgment group were younger, and had less comorbidities, and lower surgical risk scores. The cumulative 5-year incidence of the primary outcome measure in the patient rejection group was markedly higher than that in the initial AVR group, and was similar to that in the physician judgment group (60.7%, 19.0%, and 66.4%, respectively).

Conclusions:Patient rejection was the reason for non-referral to AVR in nearly one-quarter of the symptomatic patients with severe AS who were managed conservatively. The dismal outcome in patients who refused AVR was similar to that in patients who were not referred to AVR based on physician judgment despite less comorbidities and lower surgical risk scores in the former than in the latter.

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© 2019 THE JAPANESE CIRCULATION SOCIETY
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