Abstract 16224: Stroke Volume Recovery Impact on Outcomes Following Surgical Aortic Valve Replacement for Severe Aortic Stenosis
Background: In patients with aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), pre-operative indexed stroke volume (SVi) is a predictor of short-term mortality following surgical aortic valve replacement (SAVR). However, long-term predictors of mortality remain controversial. The aim of this study was to assess the impact of postoperative SVi on outcomes in patients with AS and preserved LVEF.
Methods: We examined 1,865 patients with AS and preserved LVEF who underwent SAVR. A total of 341 patients were excluded due to absent post-operative echocardiography or without reliable stroke volume measurement.
Results: Among these patients, 502 (33%) were in Paradoxical Low Flow (PLF) AS as defined by preoperative SVi of ≤35 mL/m2; and 1022 (67%) were in Normal Flow (NF) AS as defined by preoperative SVi of >35 mL/m2. Groups were subdivided according to post-operative SVi at discharge (SViD): 363 (24%) had PLF and low SViD (Persisting Low Flow); 129 (9%) had PLF and normal SViD (Normalized Flow); 597 (39%) had NF and low SViD (New Onset LF); and 435 (28%) had NF and normal SViD (Maintained NF). There were 169 deaths (11%) occurring at a mean follow-up of 33 months. After comprehensive adjustment, patients with persisting low flow have a higher late postoperative mortality (HR: 1.33; p=0.047; Table 1) and persistent echocardiographic features of low flow state (Figure 1).
Conclusion: Patients with AS showing no recovery of SVi after SAVR have a higher rate of mortality and persistent low flow state, which may be related to the pre-existing ventricular dysfunction. When PLF AS is present, early referral for SAVR must be considered as this could improve SAVR outcomes.
Author Disclosures: A. Poulin: None. M. Berthelot-Richer: None. L. Tastet: None. L. Simard: None. D. Kalavrouziotis: None. P. Pibarot: None. M. Clavel: None.
- © 2016 by American Heart Association, Inc.