Abstract 15605: Aortic Valve Replacement Improves Survival in Moderate to Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction Regardless of the Gradient or Flow Pattern: a Role for Early Aortic Valve Replacement?
Introduction: The role of aortic valve replacement (AVR) in patients with low gradient moderate to severe aortic stenosis (AS) (AVA ≤ 1.5 cm2) or high gradient moderate AS (AVA between 1-1.5 cm2), with preserved LVEF is controversial.
Hypothesis: We tested the hypothesis that AVR will be associated with improved long-term survival regardless of the gradient or flow pattern.
Methods: The study population consisted of 506 consecutive patients (age 75±9y, 57.5% males) with moderate to severe AS (AVA ≤ 1.5 cm2) and preserved LVEF (≥50%) defined at heart catheterization. Baseline Doppler-echocardiography data were available in 327 (65%) subjects. To account for measurement errors, echocardiography Doppler-derived stroke volume (SV) has been replaced by the LVOT-independent SV calculated during the heart catheterization. A median follow-up was 8.6y (IQR 3.5y-9.3y).
Results: At catheterization, a total of 62 (12%) patients had moderate AS (MAS) (AVA 1.20±0.13 cm2) while 119 (24%) and 325 (64%) ones had severe AS (AVA 0.67±0.18, p<0.001) with a low (< 40 mmHg) (LG-SAS) and a high mean pressure gradient (HG-SAS), respectively. Significantly less patients with MAS and LG-SAS than HG-SAS underwent AVR (58.1% vs. 59.7% vs. 83.1%, P<0.001). Using Doppler-echocardiography, a total of 271 patients had severe AS (AVA 0.69±0.17cm2, mean gradient 50±16mmHg). Following the recalculation of AVA, a total of 109 (40%) patients showed AVA > 1.0 cm2 while 162 (60%) patients remained with AVA ≤ 1.0cm2. AVR was independently associated with decrease in all-cause mortality in all groups (p<0.05) regardless of the gradient, SV or AVA (Figure 1, 2). In contrast, gradient pattern, SV or AVA were not predictors.
Conclusions: In moderate to severe AS, AVR improves survival regardless of gradient, flow or AVA. This advocates for the “early-AVR” rather than the “watchful waiting” strategy.
Author Disclosures: Y. Mo: None. G. Van Camp: None. G. Di Gioia: None. T. Ondrus: None. E. Barbato: None. J. Bartunek: None. M. Vanderheyden: None. M. Penicka: None.
- © 2016 by American Heart Association, Inc.