European Journal of Heart Failure Advance Access originally published online on July 11, 2009
European Journal of Heart Failure 2009 11(9):897-902; doi:10.1093/eurjhf/hfp096
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Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosis
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1 Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China
2 Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
3 Royal Brompton Hospital, London, UK
4 Department of Cardiology, Erciyes University, Erciyes, Turkey
5 Heart Centre, Norrlands University Hospital, Uemå, Sweden
* Corresponding author. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Tel: +852 2632 3846, Fax: +852 2637 3852, Email: yylam{at}cuhk.edu.hk
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Abstract |
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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 cm2] 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.
Key Words: Aortic stenosis • Aortic valve replacement • Low-flow • High-gradient • Survival
Received February 3, 2009; Revised May 17, 2009; Accepted June 10, 2009
The first two authors contributed equally to the study.