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Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures

Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures — Junaid Khan, M.D.

In the United States, up to four percent of the population over the age of 65 is affected by aortic stenosis. Yet, for every one patient treated for this condition, it is estimated that there is one patient who goes untreated. The consequences of not treating aortic stenosis are dire. The average survival of patients with the condition who are experiencing symptoms and do not receive treatment is only two years, and the five-year survival rate is less than 20 percent. Unfortunately many of these patients are not referred for surgical consultation because severity of the disease is underestimated or the operative risk is overestimated by nonsurgeons (Surgeons use the STS national database to calculate predicted risk of mortality). To better understand the prevalence of unoperated severe aortic stenosis within the Oakland community, two local cardiology groups participated with the Alta Bates Summit Research and Education Institute analyzing 101 patients with clinically severe aortic stenosis. The results were surprising: 73% of the patient cohort was not referred for surgical intervention, despite half of them reporting symptoms related to AS. Eleven of these patients died within 11 months following their last echocardiogram.

Outcomes
Aortic valve replacement surgery has advanced over the past decade. Cutting-edge procedural techniques and innovations have led to an average mortality below 5% nationwide and at the Summit Campus, even patients in their eighties with comorbidities have a lower than expected surgical risk and typically gain an additional 6 to 8 years of quality life. Age is not a contraindication for surgery and more of these patients should be considered for surgical intervention. In addition, minimally invasive techniques like port access can result in faster recovery for patients. As surgical techniques continue to improve and risk declines, efforts must continue to reduce the number of untreated patients with severe valve disease.