Abstract 2061: Severe Aortic Stenosis In Patients with Severe Left Ventricular Dysfunction: Factors Affecting Survival In A Cohort of 194 Patients
Aortic stenosis (AS) is increasingly common with aging population. There is a probable mortality benefit with aortic valve replacement (AVR) in patients with severe AS and low LV EF. There is little understanding of other prognostic variables in this high-risk population
Methods: Our echocardiographic database for the period of 1993 to 2003 was screened for severe AS (AVA ≤0.8 cm2) and LV EF ≤35%. Chart reviews were performed for clinical, pharmacological and surgical details. Survival data was obtained from social security death index.
Results: Of the 740 patients with severe AS, 194 (26%) had severe LV dysfunction defined as EF ≤35%. The mean age was 75±12 years, 58% men, EF 25±7%. The Univariate predictors of higher mortality included lower EF (p=0.04), lower mean transvalvular gradient (p=0.01), renal insufficiency (p=0.01) and lack of AVR (p<0.0001). A total of 58 (30%) patients had AVR which was associated with a relative risk of mortality of 0.38 (95% CI 0.24 – 0.58, p<0.0001, figure⇓), supported by both sensitivity and propensity score analysis. Lack of AVR and renal insufficiency were the only 2 independent predictors of mortality. Mortality benefit with AVR was present in subsets with CAD, significant MR and low transvalvular gradient. There were 72 patients with EF ≤20%, of whom 18 had AVR which was associated with a large survival benefit similar to the entire cohort.
There is a reluctance to offer AVR in a large number of patients with severe AS with EF ≤35%.
AVR is associated with a large mortality benefit in these patients, even when the EF is ≤20% and the transvalvular gradient is low.
Renal insufficiency has an adverse effect on survival in these patients