ECHO 2013 / Asymptomatic Valvular Disease When to Intervene
.pdf
AR patients with decreased EF or LVIDs > 40mm progress to develop symptoms and need AVR within 3 years (25%/yr develop symptoms)
AS
Asymptomatic Severe AS:
Is It Time to Operate ?
Pro:
Con:
All patients should be operated
Truly asymptomatic patients do not need surgery now
AVR Should be Performed in Symptomatic AS
|
100 |
|
|
|
|
|
Valve Replacement |
|
|
|
|
|
|
|
|
||
|
80 |
|
|
|
|
|
|
|
(%) |
60 |
|
|
|
|
|
|
|
Survival |
40 |
|
|
|
No surgery |
|
||
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
20 |
|
|
|
|
|
Chi-square = 23.5 |
|
|
|
|
|
|
|
p<0.001 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
p<0.05 |
p<0.001 |
|
|
|
|
|
0 |
0 |
|
|
|
|
|
|
No. at Risk |
|
1 |
2 |
Year |
3 |
4 |
5 |
|
|
|
|||||||
Valve replacement 125 |
87 |
51 |
|
35 |
9 |
0 |
||
No surgery |
|
19 |
8 |
2 |
|
1 |
0 |
0 |
Carabello |
N Engl J Med 2002;346(9) |
|
||||||
Very Severe Aortic Stenosis |
||||
|
100 |
|
|
|
(%) |
90 |
|
|
|
80 |
|
|
AV-Vel |
|
Survival |
|
|
||
70 |
|
|
4.0 to 5.0 m/s |
|
|
|
|
||
60 |
|
|
|
|
50 |
|
|
AV-Vel |
|
|
|
5.0 to 5.5 m/s |
||
Free |
40 |
|
|
|
|
|
|
||
30 |
|
|
AV-Vel |
|
|
|
|
||
- |
|
|
≥ 5.5 m/s |
|
|
|
|
||
Event |
20 |
|
|
|
|
|
|
||
10 |
p < 0.0001 |
|
|
|
|
|
|
|
|
|
0 |
|
|
|
|
0 |
1 |
2 |
3 |
|
|
|
Years |
|
Rosenhek Circulation 2010;121:151-6 |
||||
