The Changing Therapeutic Landscape for Severe Aortic Stenosis: 2013-2018

Abdulsalam, Nashwa

The Changing Therapeutic Landscape for Severe Aortic Stenosis: 2013-2018

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Nashwa Abdulsalam , University of Nebraska Medical Center, Omaha, NE

Elizabeth R Lyden , University of Nebraska Medical Center, Omaha, NE

J. Dawn Abbott, M.D., FSCAI , Brown/Rhode Island Hospital, Providence, RI

Herb D. Aronow, M.D., FSCAI , Cardiovascular Institute/Brown Medical School, Providence, RI

Hyo Jung Tak , University of Nebraska Medical Center, Omaha, NE

Poonam Velagapudi, M.D. , University of Nebraska Medical Center, Omaha, NE

Gregory Pavlides, M.D., Ph.D. , University of Nebraska Medical Center, Omaha, NE

Edward L. O'Leary, M.D. , University of Nebraska Medical Center, Omaha, NE

Yiannis Chatzizisis, M.D., Ph.D. , University of Nebraska Medical Center, Newton Center, MA

David Barton , University of Nebraska Medical Center, Omaha, NE

Andrew Michael Goldsweig, M.D., FSCAI , University of Nebraska Medical Center, Omaha, NE

Background
Therapy for severe aortic stenosis (AS) expanded with transcatheter aortic valve replacement (TAVR). In a novel "all-comers" approach, we determined trends in TAVR, surgical AVR (SAVR) and medical therapy (MT) following approval of TAVR for high- and then intermediate-risk patients.

Methods
We abstracted data for all patients with severe AS identified by echocardiography 3/2013-1/2018 at a single US center. We used Chi-square tests for patient characteristics by therapy and Cochrane-Amritage tests for temporal changes.

Results
From 2013-2018, severe AS patients increased 32%. Of 909 patients, 31% had TAVR, 61% had SAVR and 8% MT (figure A). Characteristics that differed by therapy included age, sex, prior PCI, CABG, other cardiac surgery, PAD, carotid stenosis, smoking, lung disease, AF, AI, LVEF, valve area (p<0.0001 for all), proximal LAD disease (p=0.02), mean gradient (p=0.02) and CVA (P=0.03). Over time, TAVR patients increasingly had prior aortic valve procedures (P=0.02), previous MI (P=0.004) and diabetes (P=0.005), but decreasingly had PAD (P=0.02) and lung disease (p=0.002) (figures B-F). SAVR patients increasingly had prior CABG (P=0.03) and MR (p=0.003). Trends were not identified in the small MT cohort.

Conclusions
Over the study period, TAVR steadily increased. SAVR initially increased, likely from increased AS referrals, and stabilized. MT remained infrequent. With TAVR operator experience and intermediate-risk approval, comorbidity profiles evolved in TAVR and SAVR patients.