Determinants of long-term outcome in patients with mild/moderate aortic valve stenosis

Background Previous studies on the natural history of mild/moderate aortic valve stenosis used the combined end-point of death and aortic valve replacement (AVR). Aim The aim of our study was to assess the very long-term outcome (survival) of patients with mild/moderate aortic stenosis (AS). Methods A consecutive series of 760 patients with the diagnosis of mild (AVA > 1.5 cm2–2 cm2, n = 408) and of moderate (AVR > 1 cm2–1.5 cm2, n = 352) AS during the inclusion period from 01.12.2003 to 01.05.2006 were followed. Follow-up duration ≥ 10 years in all patients. Vital status (national vital statistics) was assessed on 29.10.2016. Completeness of follow-up: 100%. Mean age: 76 ± 10 y. Logistic Euroscore: 13 ± 11; Euroscore 2010: 4.3 ± 4.9. Results Overall survival at 1–5–10 years according to AS severity was respectively for mild AS: 88%–60%–39% and for moderate AS: 85%–54%–30%. The following baseline characteristics were independently (COX model) associated with poor outcome (death following follow-up) ( Table 1 ). The severity of AS was not found to be an independent prediction of poor survival (death). Moreover the median (50%) time to AVR was 9 y. in case of moderate AS and 12 y. in case of mild AS. Conclusion In this large patients cohort (760 pts) with mild/moderate AS, the very long-term outcome (> 10 y) was depending on clinical and hemodynamic variables such as age, comorbidities, LV dysfunction, signs of heart failure and renal failure, but not on the AS severity. The severity of AS seems not to have an independent impact on overall survival.