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Valvular heart disease
Original research
Impact of selected comorbidities on the presentation and management of aortic stenosis
  1. Tanja K. Rudolph1,
  2. David Messika-Zeitoun2,
  3. Norbert Frey3,
  4. Jeetendra Thambyrajah4,
  5. Antonio Serra5,
  6. Eberhard Schulz6,
  7. Jiri Maly7,8,
  8. Marco Aiello9,
  9. Guy Lloyd10,
  10. Alessandro Santo Bortone11,
  11. Alberto Clerici12,
  12. Georg Delle-Karth13,
  13. Johannes Rieber14,
  14. Ciro Indolfi15,
  15. Massimo Mancone16,
  16. Loic Belle17,
  17. Alexander Lauten18,
  18. Martin Arnold19,
  19. Berto J Bouma20,
  20. Matthias Lutz3,
  21. Cornelia Deutsch21,
  22. Jana Kurucova22,
  23. Martin Thoenes23,
  24. Peter Bramlage21 and
  25. Richard P. Steeds24
  1. 1Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
  2. 2University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  3. 3Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
  4. 4James Cook University Hospital, Middlesbrough, Middlesbrough, UK
  5. 5Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  6. 6Cardiology Department, AKH Celle, Celle, Germany
  7. 7Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  8. 8Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  9. 9Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
  10. 10St Bartholomew's Hospital, London, UK
  11. 11University of Bari, Bari, Italy
  12. 12University of Turin, Turin, Italy
  13. 134th Medical Department, Hietzing Hospital, Vienna, Austria
  14. 14Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Germany
  15. 15Division of Cardiology and URT CNR of IFC, Magna Graecia University, Catanzaro, Italy
  16. 16Sapienza University of Rome, Rome, Italy
  17. 17Centre Hospital d’Annecy, Annecy, France
  18. 18German Centre for Cardiovascular Research (DZHK), University Heart Center & Charité, Berlin, Germany
  19. 19Department of Cardiology, University of Erlangen, Erlangen, Germany
  20. 20University of Amsterdam, Amsterdam, Netherlands
  21. 21Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
  22. 22Edwards Lifesciences, Prague, Czech Republic
  23. 23Edwards Lifesciences, Nyon, Switzerland
  24. 24Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Tanja K. Rudolph; tk.rudolph{at}me.com

Abstract

Background Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce.

Methods Prospective registry of severe patients with AS across 23 centres in nine European countries.

Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated.

Conclusions Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.

  • aortic valve disease
  • prosthetic heart valves
  • cardiac surgery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001271

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    Footnotes

    • Twitter @Richard.Steeds

    • Contributors NF, RPS, DM-Z, JK, MT and PB were involved in the conception and design of the study. PB and TKR drafted the manuscript and all other authors revised the article for important intellectual content. All authors gave final approval of the version.

    • Funding This work was supported with a research grant provided by Edwards Lifesciences (Nyon, Switzerland).

    • Competing interests PB is the representative of the IPPMed, Cloppenburg, Germany. NF, RPS, DM-Z and TKR are consultants to Edwards Lifesciences. The institutions of these three and those of the remaining authors representing study centres have received funding for employing a study nurse.

    • Patient consent for publication Not required.

    • Ethics approval The study was carried out in accordance with the Declaration of Helsinki and was approved by the independent ethics review board at each participating institution.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data are available on reasonable request from the corresponding author.