MORTALITY AND WORSENING OF PROGNOSTIC PROFILE DURING WAITING TIME FORVALVE-REPLACEMENT IN AORTIC-STENOSIS

In a prospective study 99 consecutive patients with operative indicati on due to severe aortic stenosis (AS) were put on a surgical waiting l ist. The waiting-time to aortic valve replacement (AVR) averaged 6.3 m onths (0.5-19 months). There were 58 men and 41 women with a mean age of 61 years (21-82 years). The patients were divided into three groups : group (n = 8l)with an uneventful stay on the waiting list (including one patient who declined the AVR offer); group II (n = 11) with signi ficant worsening of a prognostic index; and group III (n = 7) with pat ients who died during the waiting-time. The waiting-list death rate wa s 13.5 +/- 5.0%. patient-year(-1) compared with a post-AVR death rate of 4.9 +/- 0.9%. patient-year(-1) (p < 0.05) with a mean post-AVR foll ow-up of 5.7 years. According to their prognostic index at inclusion, group II patients had a predicted (by a Cox model) 7-year post-AVR sur vival probability of 72%, but only of 61% according to their prognosti c index immediately preoperatively; their observed 7-year post-AVR sur vival was 60%. Logistic regression analysis identified high age, short duration of symptoms, severe hypertrophy and strain in the EGG, femal e sex, and deranged left-ventricular diastolic function (related to se verely increased left-ventricular muscle mass) as independent predicto rs of death on the waiting-list and prognosis worsening. From a clinic al viewpoint, the predictive models did not allow sufficiently accurat e identification of the patients at risk during the waiting-time. The consequences of a surgical waiting-time averaging 6 months are serious for AS patients. The death rate is high and a subgroup worsen their p rognostic profile, with significantly reduced post-AVR long-term survi val as the result.