Aortic Stenosis Clinical Presentation and Survival Following Transcatheter Aortic Valve Replacement

Background - While the natural history of aortic stenosis (AS) largely depends on the severity of symptoms, the prognostic significance of AS clinical progression in patients undergoing aortic valve replacement (AVR) is less clear. Herein, we evaluate the correlation between the severity of AS presenting symptoms and survival after transcatheter AVR (TAVR).

Methods and Results - We evaluated long-term survival of a consecutive cohort of severe AS patients (n=862, mean Society of Thoracic Surgeons (STS) score 4.16±2.9) who underwent transfemoral TAVR between 2009-2016. Patients were classified as having severe symptoms (i.e. angina, syncope or heart failure, n=424) or mild symptoms (i.e. dizziness, fatigue, effort dyspnea, chest discomfort, n=438). No differences in device success nor in-hospital complications were found between groups. During a median follow-up of 2.84 (1.9-4.5) years, survival at 1, 3 and 5 years in the entire cohort, was 89±1.1%, 75±1.6% and 59±2.1%, respectively. Severe symptoms were associated with higher mortality (HR 1.54, 95% CI 1.230-1.939, p<0.001). The 1, 3 and 5-year survival was 94±1.9%, 81±3.3% and 71±4.3% in patients with angina, 92±3.3%, 75±5.6% and 56±8.2% in patients with syncope and 77±3%, 54±3.7% and 41±4.1% in patients with heart failure, respectively, (p<0.001). Heart failure symptoms emerged as independent predictor of mortality (HR1.66, 1.28-2.17, p<0.001), regardless left ventricular ejection fraction.

Conclusions - The severity of AS symptoms affects survival after TAVR and overt heart failure independently predicts early mortality. Early intervention following diagnosis of severe AS is crucial to reduce the unfavorable effects of clinical progression on survival after TAVR.