Reasons for Denying Aortic Valve Replacement (AVR)

Reasons for denying AVR

  • There were 191 unoperated patients.

  • Only 30 percent of the patients were evaluated by a cardiac surgeon.

  • Fifty-six percent of these unoperated patients had objective risk<=5%. 

  • Twenty-two percent of unoperated patients had an operative risk < median risk of operated patients. 24% of “inoperable” patients sent for percutaneous AVR ended up having open surgery AVR.

  • At Penn, 50 percent of “inoperable” patients referred for percutaneous AVR (TAVI) actually were candidates for, and got surgical AVR.

You may think, “I know my patient’s Aortic Valve is bad but she’s so sick she could never tolerate open heart surgery.” But now, not every comorbidity contraindicates valve surgery: 

  • Dementia - Yes
  • Strokes - Yes
  • Renal disease - Maybe
  • Bad left ventricle - No
  • Lung disease - No