Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Truls Myrmel, Department of Clinical Medicine, UiT - The Arctic University of Norway
- Second opponent: Professor II Per Olav Vandvik, Institute of Health and Society, Faculty of Medicine, University of Oslo
- Third member and chair of the evaluation committee: Professor II Theis Tønnessen, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
Chair of the Defence
Professor Emeritus Knut Gjesdal, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
Principal Supervisor
Senior Consultant Kjell Ingar Pettersen
Summary
Background: Aortic valve replacement (AVR) is the only curative treatment of patients with severe AS. There is an increasing demand of updated knowledge of background and outcome of AVR to be used in decision making of treatment.
Methods: Consecutively adult referred for AVR due to severe AS at our institution were invited in a prospective cohort study. In addition to routinely examination, patients were invited to perform functional and cognitively testing and fulfill health related quality of life questionnaires. All patients were assessed blinded to the decision making of treatment and assigned to a one year follow up.
Results: Our study showed that the Standard Gamble method is a valid tool to assess important patient preferences of treatment in this population. A majority of the patients were willing to accept a high to prohibitive risk of abrupt mortality during the intervention. However, the risk willingness varied considerably among patients and was poorly associated with known variables, suggesting that risk willingness should be addressed directly in the clinical encounter. Elderly patients reported few symptoms and were assessed in lower NYHA class and likely not being offered AVR. AVR was associated with a relative risk reduction of 71% for death in operated non-diabetic patients compared to non-operated. The age stratified analyses (<70 year, 70-79 and ≥80 years) showed no between group differences in readmission rate, length of stay, and complications as; myocardial infarction, permanent pacemaker implantation, heart failure or cerebrovascular during the following year after surgical AVR. All patients groups experienced meaningful gains in quality of life and improvement of functional classes without clinical meaningful decline in cognitive function at one year along with satisfactory five year survival.
Additional information
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