Abstract

CANATA, Javier Fernando et al. Comparative clinical outcome between the conservative medical management versus the surgical treatment in patients with severe aortic stenosis. Mem. Inst. Investig. Cienc. Salud [online]. 2026, vol.24, n.1, e24122603.  Epub Apr 30, 2026. ISSN 1812-9528.  https://doi.org/10.18004/mem.iics/1812-9528/2026.e24122603.

Aortic stenosis (AS) is the most common heart valve disease in developed countries and has a poor prognosis when symptoms appear. According to clinical practice guidelines, aortic valve replacement (AVR) is the treatment of choice for severe symptomatic AS. Despite current options, many patients with severe symptomatic AS are managed with pharmacotherapy. A retrospective registry included all adults with severe AS (mean gradient ≥40 mmHg or aortic valve area <1 cm²). Recorded variables included clinical and echocardiographic parameters, the Charlson comorbidity index, and EuroSCORE II. Patient survival and aortic valve intervention were reviewed. In cases treated conservatively, the main reasons for this decision were recorded. A total of 64 patients were included, with a mean age of 66.83 ± 14.30, of whom 40 (62.50%) were men and 24 (37.50%) were women. The most common therapeutic approach was conservative treatment in 38 patients (59.38%), and surgical treatment was performed in 26 patients (40.62%). Of the 22 patients who died, 17 received conservative treatment (77.27%) and 5 received surgery (22.73%). The mean post-intervention survival time was 261.67 ± 521.68 days for non-cardiac causes of death and 1183.5 ± 52.5 days for cardiac causes. Most patients with severe AS are treated conservatively. The two main reasons for choosing this option were patient choice and the presence of comorbidities. The independent predictors of mortality were comorbidity assessed by the Charlson score (>3), reduced LVEF, surgical risk (EuroSCORE II >5), diagnosis of severe AS in hospitalized patients, and renal failure.

Keywords : Severe aortic stenosis; aortic valve replacement; cardiac mortality.

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