J Thorac Cardiovasc Surg 2008;135:314-315
© 2008 The American Association for Thoracic Surgery
Discussion
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Dr Michael A. Acker
(Philadelphia, Pa). This paper is very important. I believe its import lies not in the extraordinary low mortality, for which the Mayo cardiac surgeons are to be congratulated, but rather in this very careful observation of the natural history of asymptomatic AS and also the similarities in the operative mortality between the asymptomatic and symptomatic patients undergoing AVR. I have three questions, which I will ask one at a time to give you a chance to answer.
Although you showed overall survival and benefit for just getting the valve replaced, 50% of your patients remained asymptomatic without AVR and without death at 3 years. Did you look at this group to determine preoperative characteristics such as the presence of left ventricular hypertrophy, for instance, that would be predictive of a benign course so that we do not have to operate on everyone who has severe AS?
Dr Brown. We did not specifically look at that group of patients. However, in a previous study, both a smaller aortic valve area and left ventricular hypertrophy predicted symptom development in patients with asymptomatic AS.
Dr Acker. Second question: As you know, the operative mortality across the country for AVR and aortic valve and coronary bypass surgery, according to The Society of Thoracic Surgeons database, is not 1% and 2% but rather 3.5% for AVR alone and nearly 6% for an AVR/coronary bypass. It is thus imperative, if one is considering operating on the asymptomatic patient, to know the true operative result. On the other hand, to complete that risk/benefit analysis, one would have to know the rate . . . [Full Text of this Article]
Copyright © 2008 by The American Association for Thoracic Surgery.
