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Predictors of survival after aortic valve replacement in patients with low‐flow and high‐gradient aortic stenosis
Author(s) -
Ding WenHong,
Lam YatYin,
Duncan Alison,
Li Wei,
Lim Eric,
Kaya Mehmet G.,
Chung Robin,
Pepper John R.,
Henein Michael Y.
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp096
Subject(s) - medicine , cardiology , ejection fraction , aortic valve replacement , hazard ratio , stenosis , heart failure , aortic valve stenosis , concomitant , aortic valve , proportional hazards model , confidence interval
Aims To identify predictors of survival following aortic valve replacement (AVR) in patients with low‐flow and high‐gradient aortic stenosis (AS). Methods and results Eighty‐six patients (aged 71 ± 10 years) with severe AS [aortic valve mean pressure gradient >40 mmHg or valve area <1.0 cm 2 ] and left ventricular (LV) dysfunction [ejection fraction (EF) <50%] underwent AVR. Cox proportional hazards were used to identify independent clinical and echocardiographic predictors of mortality. Operative (30‐day) mortality was 10%. Peri‐operative mortality was associated with lower mean LVEF, higher mitral E:A ratio, peak systolic pulmonary artery pressure (PSPAP), and serum creatinine (by 12%, 2.3, 28 mmHg, and 74 mmol/L, respectively, all P < 0.001), NYHA class III–IV (100 vs. 65%), concomitant CABG (89 vs. 55%), urgent surgery (78 vs. 35%), and longer bypass‐time (by 28 min, all P < 0.05). Mortality at 4 years was 17%. Univariate predictors [hazard ratio (HR)] of 4‐year mortality were: lower EF (HR 0.68 per % increase, P < 0.001), presence of restrictive LV filling (HR: 3.52, P < 0.001), raised PSPAP (HR: 1.07, P < 0.001), and CABG (HR: 4.93, P = 0.037). However, only low EF (<40%, HR 0.74, P = 0.030), the presence of restrictive filling (HR 1.77, P = 0.033), and raised PSPAP (>45 mmHg, HR 2.71, P = 0.010) remained as independent predictors after multivariate analysis. Conclusion The severity of pre‐operative systolic and diastolic LV dysfunction is the major predictor of mortality following AVR for low‐flow and high‐gradient AS.