Journal of the American College of Cardiology · 2002
Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction.
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Pereira Jeremy J, Lauer Michael S, Bashir Mohammad, Afridi Imran, Blackstone Eugene H, Stewart William J, McCarthy Patrick M, Thomas James D, Asher Craig R, New Collective Author
Аннотация
OBJECTIVE: We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low transvalvular gradient (TVG) is associated with improved survival.
BACKGROUND: The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial.
METHODS: Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group.
RESULTS: Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level.
CONCLUSIONS: Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.
BACKGROUND: The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial.
METHODS: Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group.
RESULTS: Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level.
CONCLUSIONS: Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.
Предметные рубрики MeSH
AdultAgedAged, 80 and overAortic ValveAortic Valve StenosisBioprosthesisEchocardiography, DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamicsHospital MortalityHumansIncidenceMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsRisk FactorsSeverity of Illness IndexStroke VolumeSurvival AnalysisTime FactorsVentricular Dysfunction, Left