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Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction.

Publication ,  Journal Article
Samad, Z; Vora, AN; Dunning, A; Schulte, PJ; Shaw, LK; Al-Enezi, F; Ersboll, M; McGarrah, RW; Vavalle, JP; Shah, SH; Kisslo, J; Glower, D ...
Published in: Eur Heart J
July 21, 2016

AIMS: We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. METHODS AND RESULTS: The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. CONCLUSIONS: In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 21, 2016

Volume

37

Issue

28

Start / End Page

2276 / 2286

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Humans
  • Heart Valve Prosthesis Implantation
  • Coronary Artery Bypass
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis
  • Aortic Valve
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Samad, Z., Vora, A. N., Dunning, A., Schulte, P. J., Shaw, L. K., Al-Enezi, F., … Velazquez, E. J. (2016). Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction. Eur Heart J, 37(28), 2276–2286. https://doi.org/10.1093/eurheartj/ehv701
Samad, Zainab, Amit N. Vora, Allison Dunning, Phillip J. Schulte, Linda K. Shaw, Fawaz Al-Enezi, Mads Ersboll, et al. “Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction.Eur Heart J 37, no. 28 (July 21, 2016): 2276–86. https://doi.org/10.1093/eurheartj/ehv701.
Samad Z, Vora AN, Dunning A, Schulte PJ, Shaw LK, Al-Enezi F, et al. Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction. Eur Heart J. 2016 Jul 21;37(28):2276–86.
Samad, Zainab, et al. “Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction.Eur Heart J, vol. 37, no. 28, July 2016, pp. 2276–86. Pubmed, doi:10.1093/eurheartj/ehv701.
Samad Z, Vora AN, Dunning A, Schulte PJ, Shaw LK, Al-Enezi F, Ersboll M, McGarrah RW, Vavalle JP, Shah SH, Kisslo J, Glower D, Harrison JK, Velazquez EJ. Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction. Eur Heart J. 2016 Jul 21;37(28):2276–2286.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 21, 2016

Volume

37

Issue

28

Start / End Page

2276 / 2286

Location

England

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Humans
  • Heart Valve Prosthesis Implantation
  • Coronary Artery Bypass
  • Cardiovascular System & Hematology
  • Aortic Valve Stenosis
  • Aortic Valve
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology