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Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection
Daniel Hernández-Vaquero1, Emiliano Rodríguez-Caulo2, Carlota Vigil-Escalera1
1Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Revista Espanola De Cardiologia (English Ed.)
|June 22, 2022
Summary
Patients undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis (SAS) experience a reduced life expectancy. However, those with low-gradient SAS and preserved ejection fraction have a similar survival benefit from SAVR compared to high-gradient SAS patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Severe aortic stenosis (SAS) necessitates surgical aortic valve replacement (SAVR), yet patients often face reduced life expectancy compared to the general population.
- The specific life expectancy for patients with low-gradient SAS and preserved left ventricular ejection fraction (LVEF) undergoing SAVR remains underexplored.
Purpose of the Study:
- To investigate the long-term life expectancy of patients undergoing SAVR for low-gradient SAS with preserved LVEF.
- To compare the survival outcomes of patients with low-gradient SAS and preserved LVEF against those with high-gradient SAS and preserved LVEF.
Main Methods:
- Analysis of 5084 patients aged 50-65 who underwent isolated SAVR across 27 Spanish centers over 18 years.
- Comparison of observed and expected survival at 18 years for patients with low-gradient SAS and preserved LVEF versus other SAS types.
- Propensity score matching to compare life expectancy between low-gradient and high-gradient SAS patients with preserved LVEF.
Main Results:
- Observed survival at 18 years for low-gradient SAS with preserved LVEF was 63.5%, compared to an expected survival of 75.7%.
- In propensity score-matched analysis, survival for low-gradient SAS with preserved LVEF was similar to high-gradient SAS with preserved LVEF (P=.95).
Conclusions:
- Patients with SAS undergoing SAVR experience a loss of life expectancy, particularly those with left ventricular dysfunction.
- The life expectancy loss is lower for patients with preserved LVEF, irrespective of gradient severity (low or high).
- The surgical benefit of SAVR is comparable between patients with low-gradient and high-gradient SAS, provided LVEF is preserved.
Keywords:
Aortic valve replacementEsperanza de vidaEstenosis aórtica graveLife expectancyRecambio valvular aórticoSevere aortic stenosisMore Related Videos
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