Abstract 14204: Long-Term Outcome After Aortic Valve Replacement of Patients With Prosthesis-Patient Mismatch and Paradoxical Low Flow, Severe Aortic Stenosis
Background: Previous studies have shown patients with severe AS and paradoxical low flow (PLF) (indexed stroke volume (SVi) ≤ 35 mL/m2 and preserved LVEF (≥ 50%) have worse outcome compared to those with severe AS but a normal flow. Moreover, Prosthesis-Patient Mismatch (PPM) after aortic valve replacement (AVR) is a predictor of higher mortality. However, the prevalence and impact of PPM in patients with PLF-AS on survival is unknown.
Aim: was to analyze prevalence and impact on long-term survival of PPM in patients with PLF-AS.
Methods and results: Between 2000 and 2010, 1407 patients had cardiac catheterization at our institution for preoperative evaluation of AS severity and coronary artery disease. After exclusion of those with significant other valvular heart disease and/or LVEF<50%, 677 patients who received AVR, were included (74±8 years, 42% women, 46% with coronary artery disease, AVA 0.69±0,16cm2 and mean gradient 49±16 mmHg). 26% of patients had PLF-AS. After AVR, 54% of patients had at least moderate PPM, whereas 15% had simultaneous PLF and PPM. Compared to patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. LVEF, SVi and pulmonary arterial pressures were also significantly deteriorated in the group PLF/PPM (all p<0.05). They received more often combined CABG, and bioprostheses. Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in the PLF/PPM (37±9%) group compared to noPLF/noPPM (70±5%, p=0.002) by multivariate analysis (HR=2.68; CI: 1,5-4,4; p=0.0003)
Conclusion: This large catheterization-based study shows patients with PLF-AS and post operative PPM have worse outcome, compared to those with noPLF/noPPM. Patients with PLF-AS are at an advanced stage of their disease and every effort should be made to prevent the occurrence of PPM in patients with PLF-AS despite their apparently preserved LVEF.
- © 2013 by American Heart Association, Inc.