Grant: Travel Awards - Institute Community Support

Having a severe yet treatable disease while doctors are reluctant to prescribe the treatment is an undesirable situation. This is happening for patients who suffer from aortic stenosis (AS) and severe heart failure (HF). They are perceived to be in such an advanced disease that therapeutic benefit (from surgical or trans-catheter aortic valve replacement (AVR)) is not likely. AS consists in progressive stiffening of the aortic valve, which narrows the aortic orifice. This leads to compensatory left ventricular hypertrophy, which mantains a normal cardiac performance. In advanced AS, left ventricular hypertophy becomes ineffective and cardiac performances are no longer sufficient to supply the body needs, defining the HF state. HF increases the risk associated with the AVR procedure. Thus, in clinical practice doctors are reluctant to prescribe AVR in the presence of HF and AS. However, the degree of HF that renders AVR futile is unknown. In clinical practice, heart failure severity is graded by left ventricular ejection fraction (LVEF) i.e. the proportion of blood pumped to the circulation during each heart beat. Normal LVEF is > 55%. Very low LVEF <25% dcreases the likelihood for a patient to be prescribed AVR. A failing heart is more vulnerable to AS than a normally functioning one. Hence, AS patients with severe HF are facing a double whammy.Therefore, the need for AVR is even more urgent than in AS patients with preserved hearts. In this conference paper, we demonstrate that patients with LVEF <25% i) derive similar survival benefit from AVR as patients with LVEF>25% and ii) have a markedly improved survival after AVR as compared to untreated patients. We found that more than 50% of the patients die within 2 years if left without treatment, a rate that could be reduced to 20% with AVR. We believe that our study delivers an important and convincing message to physicians and might lead to a favourable change in clinical practice.