NEW YORK (Reuters Health) – Patients with severe symptomatic aortic stenosis who need aortic valve replacement should have the surgery as soon as possible, new research suggests.
"Our research highlights the importance of treating aortic stenosis in a timely fashion. Delays lead to unnecessary risk and patients should ideally have an aortic valve replacement within a month of diagnosis," Dr. Chris Malaisrie of Northwestern University, Feinberg School of Medicine, in Chicago, Illinois, told Reuters Health by email.
Without intervention, severe symptomatic aortic stenosis (AS) is associated with a high mortality rate. But the impact of waiting time for aortic valve replacement (AVR) has not been reported, until now, Dr. Malaisrie and colleagues note in a report online September 18 in Annals of Thoracic Surgery.
Among 1,005 patients with severe symptomatic AS they identified, 823 (82%) were advised to have AVR, and 721 (87.6%) did. Their mean age was 75.7 years.
The median waiting time for surgical or transcatheter AVR was 2.9 weeks, but one in five patients waited more than six weeks, the researchers found.
The researchers found that the risk of dying while waiting for AVR was most pronounced during the first six months after the date the patient was recommended for AVR. The mortality rate was 3.7% at 30 days and 11.6% at six months.
"This significant mortality while waiting for AVR is higher than the 30-day mortality after AVR (including both SAVR and TAVR, 30-day mortality was 3.9%)," the researchers note.
For patients who underwent AVR, waiting time was not associated with overall survival.
Based on their findings, the researchers say delaying AVR beyond one month "should be avoided."
"Although waiting time was not associated with an increased risk of 30-day mortality and morbidity in patients who underwent AVR, many patients may die while waiting for intervention," they point out.
"Patients and physicians should proceed with AVR in patients with AS on a semi-urgent, rather than elective, basis," they conclude.
The researchers say their study has several limitations. "The first is that the reason for delay in operation is not known. Although we showed that 90.6% of patients who underwent AVR did so by the 10th week after the recommendation date, their true intentions regarding waiting were not entirely known."
"Second," the team adds, "some patients may have declined AVR despite our recommendations. These patients were not analyzed in our study because they did not return and were lost to follow-up. Finally, unlike formal waiting lists in countries outside the United States, patients were not prioritized in a systematic fashion. Rather than following a queue, timing of AVR was dependent on patient wishes and physician discretion."
