Aortic stenosis patients accept high perioperative risk

A majority of patients with severe aortic stenosis would accept a high risk of dying during aortic valve replacement, according to Amjad Iqbal Hussain‘s PhD thesis.


MAIN RESULTS:

  1. Many patients with severe aortic stenosis are willing to accept an unacceptably high risk of dying during surgery.
  2. Patients above 80 years of age have important gains in health measures following aortic valve surgery.

THESIS DEFENCE:

Thesis: Decision-making in patients with severe aortic valve stenosis referred for evaluation of aortic valve replacement
Candidate: Amjad Iqbal Hussain
Time: April 1, 2019 at 13:15
Place: Oslo University Hospital, Rikshospitlaet B: Seminarrom 3
Link to university website


SUMMARY:

(1) Hussain’s first paper shows that the Standard Gamble method is a good way to find out how high risk a patient with aortic stenosis is willing to accept during surgery. The patients understood and found it easy to perform the standard gamble task, and risk willingness was less assiociated with mental health than with physical limitations and self-perceived health. 439 patients assessed for surgery due to severe aortic stenosis were included in the study.

(2) A fifth of the patients are willing to go through surgery even if the risk of dying is above 50 %. 4 % of the patients accepted a risk of 95 % or higher, whereas 70 % accepted higher risk of dying than 8 %. One fourth of the patients were not willing to go through surgery at any risk.

The willingness to risk death during surgery varied among patients and was not associated with age, sex, education and comorbid cardiovascular disease. Self-reported quality of life and burden of symptoms predicted risk willingness.

(3) Also patients older than 80 years old experience clinically meaningful improvements in life quality and functional class one year after surgery. There was no significant decline in cognitive function. The length of stay, rehospitalization rate and cardiovascular events during follow-up was not higher than for younger patients. The risk of dying within five years of surgery was 34 %, almost three-fold higher than for those aged younger than 70.

This study includes 351 patients who underwent surgical aortic valve replacement. Elderly patients were less likely to be offered surgery. Operated patients had 71 % lower risk of death during follow-up than patients not offered surgery.


REFERENCES:

(1) Hussain, A. I., Garratt, A. M., Beitnes, J. O., Gullestad, L., & Pettersen, K. I. (2016). Validity of standard gamble utilities in patients referred for aortic valve replacement. Quality of Life Research25(7), 1703-1712.

(2) Hussain, A. I., Garratt, A. M., Brunborg, C., Aakhus, S., Gullestad, L., & Pettersen, K. I. (2016). Eliciting Patient Risk Willingness in Clinical Consultations as a Means of Improving Decision‐Making of Aortic Valve ReplacementJournal of the American Heart Association5(3), e002828.

(3) Hussain, A. I., Auensen, A., Brunborg, C., Beitnes, J. O., Gullestad, L., & Pettersen, K. I. (2018). Age-dependent morbidity and mortality outcomes after surgical aortic valve replacementInteractive cardiovascular and thoracic surgery27(5), 650-656.