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Impact of stroke volume on severe aortic stenosis in patients with normal left ventricular function

Shinya Fukui1, Yumi Kakizawa2, Kazuma Handa2

  • 1Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan. fukui0104@yahoo.co.jp.

General Thoracic and Cardiovascular Surgery
|July 10, 2019
PubMed

Insights

Low-flow aortic stenosis (AS) with preserved ejection fraction has worse outcomes. Patients with low-flow AS experienced higher mortality and lower survival rates after aortic valve replacement compared to normal-flow AS.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Aortic stenosis (AS) with low flow (LF) and normal ejection fraction (EF) is associated with a poorer prognosis than normal-flow (NF) AS.
  • The impact of stroke volume on survival in patients with AS and preserved EF requires further investigation.

Purpose of the Study:

  • To assess the effect of stroke volume index (SVI) on early and long-term survival in patients with AS and normal EF undergoing aortic valve replacement.
  • To compare the outcomes of patients with LF AS versus NF AS.

Main Methods:

  • A cohort of 179 patients with AS and normal EF (≥50%) from 2007-2016 were divided into LF (SVI < 35 ml/m², n=12) and NF (SVI ≥ 35 ml/m², n=167) groups.
  • Preoperative echocardiography was used to assess hemodynamic parameters.
  • Early and long-term survival rates were compared between the two groups.

Main Results:

  • The LF group had smaller end-diastolic diameters and aortic valve areas compared to the NF group.
  • Hospital mortality was significantly higher in the LF group (16.7%) than in the NF group (1.8%).
  • Five-year overall survival was lower in the LF group (58%) compared to the NF group (84%).

Conclusions:

  • Patients with LF AS exhibit worse operative and long-term outcomes compared to those with NF AS, despite preserved left ventricular function.
  • Stroke volume is a critical determinant of survival in patients with AS and preserved EF undergoing aortic valve replacement.
Abstract

Keywords:
Low flowNormal left ventricular functionSevere aortic stenosisSurvival

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