Outcome of isolated aortic valve replacement in patients with classic and paradoxical low-flow, low-gradient aortic stenosis

López-Marco, Ana; Miller, Harriet; Kumar, Pankaj; Ashraf, Saeed; Zaidi, Afzal; Bhatti, Farah; Ionescu, Adrian; Youhana, Aprim

doi:10.1016/j.jtcvs.2017.02.056

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…The survival rate in this patient population is low (40-60% at 2 years) with conservative management but 30-day mortality after SAVR is anyway high (8-33%). [19][20][21][22][23][24][25][26][27][28][29][30] In-hospital mortality of our series is 3.4% and comparable with the data reported by Lopez-Marco et al, 31 mortality concerns the classical LF-LG, in comparison with the other groups and these data are consistent with the high mortality rate reported in the literature. Surgery is anyway feasible, as it allows improvement in quality of life.…”

Section: Discussionsupporting

confidence: 93%

“…The survival rate in this patient population is low (40–60% at 2 years) with conservative management but 30-day mortality after SAVR is anyway high (8–33%) 19–30 . In-hospital mortality of our series is 3.4% and comparable with the data reported by Lopez-Marco et al , 31 whereas 1-year mortality is 5%, lower in comparison with the 14% reported. Higher mortality concerns the classical LF-LG, in comparison with the other groups and these data are consistent with the high mortality rate reported in the literature.…”

Section: Discussionsupporting

confidence: 80%

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Surgical aortic valve replacement for low-gradient aortic stenosis

Brega

Calvi

et al. 2022

Journal of Cardiovascular Medicine

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AimsLow-gradient aortic stenosis is a challenging entity that needs accurate preoperative evaluation. For this high-risk patient population, ad hoc predictive scores are not available and profile risk is currently revealed by the EuroSCOREs. Aims of this study are to verify the suitability of the ES II as predictor of mortality in low-gradient aortic stenosis and to analyse the role of surgery as a treatment.MethodsFrom June 2013 to August 2019, 414 patients underwent surgical aortic valve replacement for low-gradient aortic stenosis. Mean age was 75.78 ± 6.77 years and 190 were women. The prognostic value of Logistic EuroSCORE and EuroSCORE II were compared by receiver-operating characteristics (ROC) curve analysis.ResultsIn-hospital, 30-day and 1-year mortality rates were respectively 3.4, 2.9 and 4.8% (14, 12 and 20 patients over 414). In-hospital mortality risk calculated by the Additive EuroSCORE was 7.2 ± 2.7%, by the Logistic EuroSCORE was 9 ± 5.2% and by the ES II was 4.13 ± 2.56%. The prognostic values of the EuroSCORE II and of the EuroSCORE were analysed in a ROC curve analysis for the prediction of in-hospital mortality [area under the curve (AUC): 0.62 vs. 0.58], 30-day mortality (AUC: 0.63 vs. 0.64) and 1-year mortality (AUC: 0.79 vs. 0.65). Both scores did not show significant differences with the only exception of 1-year mortality, for which EuroSCORE II had a better predictive ability than the Logistic EuroSCORE (P < 0.05).ConclusionIn low-gradient aortic stenosis undergoing surgery, the EuroSCORE II is a strong predictor of 1-year mortality.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 80%

Surgical aortic valve replacement for low-gradient aortic stenosis

Brega

Calvi

et al. 2022

Journal of Cardiovascular Medicine

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“…In the study by Clavel et al , compared to cLF-LGAS, patients with pLF-LGAS undergoing AVR were more frequently female and had lower prevalence of comorbidities such as chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) and chronic kidney disease (CKD) [10]. Lopez-Marco et al documented a higher proportion of females, greater incidence of hypertension and previous neurologic events as well as lower prevalence of diabetes and COPD in patients with pLF-LGAS undergoing AVR as compared to those with cLF-LGAS [11]. In other studies, the comorbidity profile of pLF-LGAS patients did not differ from HGAS patients with comparable age, occurrence of hypertension, diabetes, obesity, CAD and previous MI [9, 12].…”

Section: Discussionmentioning

confidence: 99%

Paradoxical low-flow aortic stenosis – baseline characteristics, impact on mortality

Zbroński

Huczek

Gawałko

et al. 2019

pwki

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Introduction Paradoxical low-flow, low-gradient aortic stenosis (pLF-LGAS) constitutes an important part of the population undergoing transcatheter aortic valve implantation (TAVI). However, it remains the least defined subtype of aortic stenosis (AS). Aim To investigate baseline characteristics and impact on mortality of pLF-LGAS in patients treated with TAVI. Material and methods Two-hundred and thirty-one consecutive patients (mean aortic valve area: 0.76 ±0.41 cm 2 ) who underwent TAVI in our centre during the period of 6 years were included in the study. Based on echocardiographic examination, patients with pLF-LGAS were identified, analysed and compared to a population with high-gradient AS (HGAS) and low-flow, low-gradient AS with reduced ejection fraction (classical, cLF-LGAS). The primary endpoints of the study were all-cause mortality after 30 days and 1 year. Results pLF-LGAS was diagnosed in 42 (18.2%) patients, whereas 40 (17.3%) had cLF-LGAS and 149 (64.5%) had HGAS. The pLF-LGAS population was younger, had higher prevalence of hypertension, and had higher ejection fraction (EF) than the HGAS population, and had a smaller proportion of heavily symptomatic patients than the cLF-LGAS population. Overall, 46 (19.9%) patients died within 12 months after TAVI. The 30-day and 1-year survival was comparable between AS subtypes. Multivariate analysis identified severe renal failure as an independent predictor of mortality among all patients. Conclusions pLF-LGAS is common among subjects undergoing TAVI. Patients with paradoxical AS are younger, more often burdened with hypertension and have higher EF than the HGAS population, while being less symptomatic than the cLF-LGAS group. Presence of pLF-LGAS does not seem to affect short- and mid-term survival. Severe renal failure is an independent predictor of mortality after TAVI.

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Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis in Women: Clinical Characteristics and Outcomes

Pacheco

Henri

Forcillo

et al. 2018

Canadian Journal of Cardiology

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Outcome of isolated aortic valve replacement in patients with classic and paradoxical low-flow, low-gradient aortic stenosis

Abstract: AVR can be performed in LFLG AS with low in-hospital mortality. CLFLG AS carries similar in-hospital mortality to PLFLG AS but greater mid-term mortality. Surgery provided excellent functional status among survivors.

Cited by 4 publications

References 31 publications

Surgical aortic valve replacement for low-gradient aortic stenosis

Surgical aortic valve replacement for low-gradient aortic stenosis

Paradoxical low-flow aortic stenosis – baseline characteristics, impact on mortality

Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis in Women: Clinical Characteristics and Outcomes

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