Abstract 14684: Preoperative Systolic and Diastolic Dysfunction Predicts Postoperative Survival Following Aortic Valve Replacement for Severe Aortic Stenosis
Introduction: Calcific aortic valve stenosis (AS) leads to left ventricular pressure overload, hypertrophy and fibrosis. Available data suggest myocardial fibrosis and diastolic dysfunction persist despite successful aortic valve replacement (AVR).
Hypothesis: We hypothesize that preoperative echocardiographic diastolic dysfunction will adversely impact intermediate-term mortality after successful AVR for severe AS.
Methods: We retrospectively reviewed consecutive patients with isolated severe AS undergoing AVR between 2002 and 2012. A total of 1,989 subjects were included in the analysis. The primary end-point was all-cause mortality following AVR. The influence of various clinical and echocardiographic parameters on mortality was evaluated with cox proportional hazards regression. Kaplan Meier estimates were used for survival analysis.
Results: Results are shown in the table. Mean follow up was 64±37 months and all-cause mortality occurred in 720 subjects (36%). Preoperative E/e’ and left ventricular ejection fraction (LVEF) were strong univariate correlates and independent predictors of mortality postoperatively. Patients with E/e’ >15 (n=1021) and a LVEF <50% (n=251) suffered excess mortality after AVR (29% vs 17% and 41% vs 24% at 5 years, respectively; p<0.0001 for both; figure).
Conclusions: After adjusting for clinical risk factors, E/e’ and LVEF were independent predictors of mortality after AVR for severe AS. Current guidelines support AVR for severe AS with symptoms or after a drop in LVEF. Our data suggest that AVR should be considered before the onset of impaired LVEF or diastolic dysfunction, which adversely impact postoperative survival.
Author Disclosures: M. Balakrishnan: None. J. Thaden: None. J. Sanchez: None. V. Nkomo: None. M. Eleid: None. J. Dahl: None. C. Scott: None. S. Pislaru: None. J. Oh: None. H. Schaff: None. P. Pellikka: None.
- © 2016 by American Heart Association, Inc.