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Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?

Claire Bouleti 1, 2, 3 Morgane Michel 4 Antoine Jobbe Duval Thibaut Hemery 5, 6 Pierre-Philippe Nicol 7 Romain Didier 8 Floriane Zeyons 9 Oualid Zouaghi Didier Tchetche 10 Clemence Delon Maxence Delomez Alain Dibie 11 David Attias 10 Herve Le Breton 12 Bertrand Cormier 13 Jean-Francois Obadia 14 Christophe Tribouilloy 15, 16 Emmanuel Lansac 11 Karine Chevreul 4, 17 Nicole Naccache Helene Eltchaninoff 5, 6 Martine Gilard 18 Bernard Iung 19
Abstract : Background. - According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II < 4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. Aim. - The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. Methods. - In September and October 2016, 1049 consecutive patients aged >= 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. Results. - Mean age was 84 +/- 5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II > 8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II <= 4%) in 48%. TAVI was preferred in 71% of patients, SAVR in 19% and medical treatment in 10%. The choice of TAVI over SAVR was associated with older age (P < 0.0001) and a higher EuroSCORE II (P = 0.008). However, the weight of EuroSCORE II in therapeutic decision making markedly decreased after the age of 80 years. Indeed, 77% of patients aged >= 80 years were referred for TAVI, despite a low estimated surgical risk. Conclusions. - The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention. (C) 2021 Elsevier Masson SAS. All rights reserved.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03579634
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Soumis le : vendredi 18 février 2022 - 11:00:00
Dernière modification le : jeudi 7 avril 2022 - 13:58:33

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Claire Bouleti, Morgane Michel, Antoine Jobbe Duval, Thibaut Hemery, Pierre-Philippe Nicol, et al.. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age?. Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2021, 114 (10), pp.624-633. ⟨10.1016/j.acvd.2021.06.011⟩. ⟨hal-03579634⟩

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