Abstract 18243: Does Aortic Valve Intervention Improve Outcome in Patient With Low Gradient Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function?
Introduction: Prior studies have showed discrepancy in prognosis in patients with low gradient severe aortic stenosis (LG SAS) with preserved left ventricular ejection fraction (LVEF). It is unknown whether aortic valve intervention (AVI) could improve outcome in the presence of comorbidities.
Hypothesis: Comorbidities significantly impact on the effectiveness of AVI.
Methods: The study enrolled 186 patients with LG SAS (mean gradient, MPG < 40 mmHg, aortic valve area AVA ≤ 1.0 cm2, LVEF ≥50%). Patient’s comorbidities and risk factors were assessed using the Society of Thoracic Surgery (STS) scores. Patients were divided into Group I (STS score ≥4, mean= 6.9 ±3.4, n=88) and Group II (STS scores <4, mean=2.7±0.9, n=98) and followed up for mean 2 years (2.6±1.7). AVI includes either surgical or transcatheter aortic valve replacement. All-cause mortality was analyzed.
Results: There were no significant differences in mean PG (26±11 vs. 29±13 mmHg, p=0.35), AVA (0.81±0.17 vs. 0.80±0.14 cm2, p=0.64), stroke volume index (35±10 vs. 35±8ml/m2, p=0.76) and LVEF (58% vs. 58%, p=0.61) between the two groups. Systolic pulmonary artery pressures were significantly higher in Group I than Group II (42±16 vs 36±12 mmHg, p<0.001). There were no significant differences in 3-year cumulative survival between patients with medical treatment and those with AVI in Group I (59% vs 64%, p=0.94). There were no significant differences in survival in the first three-year between medical treatment and AVI in Group II (93% vs. 86%, p=0.21). However, a survival curve was diverted after three years (Figure) in Group II with a better survival in AVI than medical treatment.
Conclusion: Patients with LG SAS and multiple comorbidities have poor prognosis and AVI did not improve survival compared to medical management. There is potential long-term benefit of AVI in patients with a fewer comorbidities suggesting that further study is needed before wide use of AVI in all patients with LG SAS.
Author Disclosures: M. Pu: None. Y. Fan: None. B. Stacey: None. R. Applegate: None. H. Shen: None. S. Gandhi: None. B. Upadhya: None. S. Vasu: None. D. Zhao: None.
- © 2016 by American Heart Association, Inc.