Abstract 16551: Preoperative Heart Failure Has Major Independent Adverse Impact on Long Term Survival in Surgically Treated Severe Aortic Stenosis Patients: Implications for Timing of Surgery
Background: Aortic stenosis (AS) is the commonest cause of valve surgery in the United States. The preoperative predictors of perioperative mortality have been well characterized, in severe AS patients undergoing aortic valve replacement (AVR). We hypothesized that onset of heart failure (HF) in severe AS patients may have long term consequences on survival because of the associated myocardial or neurohormonal changes which may persist even after AVR.
Methods: We examined this question in a cohort of 740 consecutive severe AS (defined as aortic valve area <0.8 cm2) patients seen in our echocardiographic laboratory between 1993 and 2003. Of these 287 patients had AVR forming the study cohort. Preoperative clinical, pharmacologic and surgical data were abstracted, and related to survival obtained from chart review or the National Death Index.
Results: Patient characteristics of 287 AVR patients included: age 71+12 years, 54% males, left ventricular (LV) ejection fraction 57+19%, coronary artery disease in 55%, hypertension in 35%, diabetes mellitus in 22%, and serum creatinine level >2 mg/dl in 10%. Clinical HF was present in 43% of the patients. Over a follow up of 13 years, there were 185 deaths. The univariate predictors of higher mortality included higher age (HR 1.004 per year, p<0.0001), preoperative heart failure (HR 2.2, p<0.0001), renal insufficiency (HR 2.0, p=0.0.001), COPD (HR 1.7, p=0.01), 3 or 4+ mitral regurgitation (HR 1.7, p=0.0002), and LV ejection fraction <55% (HR 1.7, p=0.0004), but not angina, diabetes mellitus, coronary disease, gender or aortic valve area. On multivariate Cox regression analysis, heart failure (HR 1.6, 95% CI 1.1-2.2, p=0.004), renal insufficiency (HR 1.6, 95% CI 0.9-2.5, P=0.06) and age (HR 1.04, 95% CI 1.01-1.05, p<0.0001) were the only independent predictors of survival.
Conclusions: (1) In severe AS patients undergoing AVR, the long term survival is adversely affected in an independent fashion by the presence of preoperative heart failure (2) We suggest that in view of the sinister consequences of heart failure on long term survival even after AVR, timing of surgery should be considered early enough even before subclinical stage of heart failure develops.
- © 2011 by American Heart Association, Inc.