Abstract 3959: Impact of Aortic Valve Replacement on Survival of Patients With Severe Aortic Stenosis With Low Transvalvular Gradient and Preserved Left Ventricular Ejection Fraction
Background Severe aortic stenosis (SAS) with low transvalvular gradients (LTG), normal left ventricular ejection fraction (LVEF) is often misdiagnosed, leading to the undertreatment of patients because the absence of a clear indication for surgery. We assessed the outcome of aortic valve replacement (AVR) in patients with SAS, LTG and normal LVEF.
Methods Between 1985 and 2008, we evaluated 73 patients who underwent AVR and 29 patients who did not undergo AVR, with aortic valve area ≤1.0 cm2, LVEF >50 %, and mean gradient ≤30 mmHg. Multivariate analysis and propensity scores were used to compare survival according to whether or not AVR was performed.
Results Compared to control patients, AVR patients were younger and with a higher body mass index. Coronary artery bypass was performed simultaneously in 38 (52%) AVR patients. A stroke volume index ≤35 ml/m2, was present in 20 (27.4%) AVR patients and in 6 (20.7%) controls, respectively (P=0.5). Operative mortality rate was 2.7%. At follow-up (median 40 months, IQR 22–75) survival was longer in AVR patients compared to controls (figure 1A⇓). By multivariate analysis, AVR was a major predictor of lower mortality (OR 0.2; 95% CI 0.07–0.5; P=0.002). Other predictors of mortality were renal failure (serum creatinine >1.5 mg/dL, OR 9.6; 95% IC 2.2–41; P=0.002) and end-diastolic volume index (OR/10 ml/m2 1.3; 95% IC 1.02–1.7; P=0.036). In 61 propensity-matched patients, the 44 AVR patients showed a significant improvement in survival compared to control group (figure 1B⇓).
Conclusions In patients with SAS/LTG and normal LVEF, AVR was associated with low operative mortality and significant improvement in survival compared to medical management.