1. Clinical outcomes and revascularization strategies in patients with low-flow, low-gradient severe aortic valve stenosis according to the assigned treatment modality.
- Author
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O'Sullivan CJ, Englberger L, Hosek N, Heg D, Cao D, Stefanini GG, Stortecky S, Gloekler S, Spitzer E, Tüller D, Huber C, Pilgrim T, Praz F, Buellesfeld L, Khattab AA, Carrel T, Meier B, Windecker S, and Wenaweser P
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Coronary Artery Disease complications, Coronary Artery Disease diagnosis, Coronary Artery Disease mortality, Coronary Artery Disease physiopathology, Coronary Circulation, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Humans, Kaplan-Meier Estimate, Male, Myocardial Revascularization adverse effects, Myocardial Revascularization mortality, Proportional Hazards Models, Registries, Risk Factors, Severity of Illness Index, Stroke Volume, Switzerland, Time Factors, Treatment Outcome, Ventricular Function, Left, Aortic Valve physiopathology, Aortic Valve Stenosis therapy, Cardiac Catheterization methods, Coronary Artery Disease therapy, Heart Valve Prosthesis Implantation methods, Hemodynamics, Myocardial Revascularization methods
- Abstract
Objectives: This study compared clinical outcomes and revascularization strategies among patients presenting with low ejection fraction, low-gradient (LEF-LG) severe aortic stenosis (AS) according to the assigned treatment modality., Background: The optimal treatment modality for patients with LEF-LG severe AS and concomitant coronary artery disease (CAD) requiring revascularization is unknown., Methods: Of 1,551 patients, 204 with LEF-LG severe AS (aortic valve area <1.0 cm(2), ejection fraction <50%, and mean gradient <40 mm Hg) were allocated to medical therapy (MT) (n = 44), surgical aortic valve replacement (SAVR) (n = 52), or transcatheter aortic valve replacement (TAVR) (n = 108). CAD complexity was assessed using the SYNTAX score (SS) in 187 of 204 patients (92%). The primary endpoint was mortality at 1 year., Results: LEF-LG severe AS patients undergoing SAVR were more likely to undergo complete revascularization (17 of 52, 35%) compared with TAVR (8 of 108, 8%) and MT (0 of 44, 0%) patients (p < 0.001). Compared with MT, both SAVR (adjusted hazard ratio [adj HR]: 0.16; 95% confidence interval [CI]: 0.07 to 0.38; p < 0.001) and TAVR (adj HR: 0.30; 95% CI: 0.18 to 0.52; p < 0.001) improved survival at 1 year. In TAVR and SAVR patients, CAD severity was associated with higher rates of cardiovascular death (no CAD: 12.2% vs. low SS [0 to 22], 15.3% vs. high SS [>22], 31.5%; p = 0.037) at 1 year. Compared with no CAD/complete revascularization, TAVR and SAVR patients undergoing incomplete revascularization had significantly higher 1-year cardiovascular death rates (adj HR: 2.80; 95% CI: 1.07 to 7.36; p = 0.037)., Conclusions: Among LEF-LG severe AS patients, SAVR and TAVR improved survival compared with MT. CAD severity was associated with worse outcomes and incomplete revascularization predicted 1-year cardiovascular mortality among TAVR and SAVR patients., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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