Abstract 14699: Patterns of Postoperative Transprosthesis Aortic Valve Gradients Predict Bioprosthetic Structural Valve Deterioration
Objectives: To identify 1) patient, procedure, and postoperative variables associated with the development of structural valve deterioration (SVD) in bioprosthetic aortic valves (AV), and 2) the relation between the initial and increasing postoperative gradients requiring explant for SVD
Methods: From 1982 to 2011, 5,006 patients underwent aortic valve replacement (AVR) with a pericardial PERIMOUNT bioprosthesis and had at least 2 postoperative echocardiograms available for analysis. Mean size of the implanted prosthesis was 23±2.3 mm. Joint modeling of longitudinal AV mean gradient and time to explant for SVD was performed to assess the effect of pattern parameters on risk of explant for SVD.
Results: Mean initial AV gradient was 14±3.0 mmHg. Mean increase in gradient was 0.51±0.74 mmHg/year. One hundred eighteen patients underwent prosthesis explant for SVD. The majority of patients had no to minimal gradient increase over 15 years. A small percentage had progressive gradient increase. Rate of mean gradient increase correlated with risk of explant (P<.0001; Figure). This effect was evident at a rate of increase above 1.5 mmHg/year. A sharper increase was associated with younger age, isolated AV replacement, smaller prosthesis size, and lower creatinine.
Conclusion: After AVR with PERIMOUNT bioprosthesis, most patients have very stable gradients out to 15 years. A rate of AV gradient increase of ≥1.5 mmHg/year is predictive of SVD and need for early future reintervention. In contrast to current guidelines, early frequent echocardiographic surveillance is warranted.
Figure legend: Effect of rate of change of aortic valve (AV) mean gradient (MnGrad) for different starting gradients on the risk of explant for structural valve deterioration (SVD).
Author Disclosures: T. Attia: None. E. Soltesz: Consultant/Advisory Board; Modest; St jude medical, Edwards Lifesciences. Other; Modest; St jude medical (Speaker), Edwards Lifesciences (Speaker), Atricure (Speaker/ Proctor), Jace medical (Royalties). J. Rajeswaran: None. E. Roselli: Consultant/Advisory Board; Significant; Medtronic. Other; Modest; Edwards lifesciences (Speaker), St Jude (Speaker). Other; Significant; Sorin group. N.G. Smedira: None. J.F. Sabik III: Consultant/Advisory Board; Modest; Medtronic, Sorin. Other; Modest; Abbott (Research funding/ US PI for Excel Trial)), Edward lifesciences (Research Funding /Local PI for Intuity Trial). L. Svensson: None. E.H. Blackstone: None. D.R. Johnston: Consultant/Advisory Board; Modest; Edwards Lifesciences, St Jude Medical.
- © 2015 by American Heart Association, Inc.