Amjad Iqbal Hussain successfully defended his thesis “Decision-making in patients with severe aortic valve stenosis referred for evaluation of aortic valve replacement” in April 2019.

Aortic valve replacement (AVR) is the only curative treatment for patients with severe aortic stenosis (AS). There is an increasing demand on updated knowledge on background and outcome of AVR to be used in decision making of treatment.

Consecutive adults referred for AVR due to severe AS at our institution were invited to a prospective cohort study. In addition to routine examination, patients were invited to perform functional and cognitive testing and fulfill health related quality of life questionnaires. All patients were assessed blinded to decision making of treatment and assigned to a one-year follow-up. 

Our study showed that the Standard Gamble method, a method used to assess patients risk willingnes in the face of uncertainty, 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 (New York Heart Association) class and likely not being offered AVR. AVR was associated with a relative risk reduction of 71% for mortality in operated non-diabetic patients compared to non-operated.
The age stratified analyses (<70 year, 70-79 and ≥80 years) showed no difference between groups in readmission rate, length of stay, and complications as; myocardial infarction, permanent pacemaker implantation, heart failure or cerebrovascular incidenses during the following year after surgical AVR. 
All patient groups experienced meaningful gains in quality of life and improvement of functional classes without clinically meaningful decline in cognitive function at one year along with satisfactory five year survival.