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Long-Term Outcomes in Moderate and Severe Aortic Stenosis According to Extent of Cardiac Damage

Domenico Angellotti1, Christoph Ryffel2, Lisa Schmid3

  • 1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy.

JACC. Cardiovascular Interventions
|October 29, 2025
PubMed

Insights

Cardiac damage extent significantly impacts 10-year mortality in aortic stenosis (AS) patients. Aortic valve replacement (AVR) improved survival, especially in severe AS with advanced cardiac damage (CD).

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Prognostics

Background:

  • Cardiac damage (CD) is a critical factor influencing prognosis in patients with aortic stenosis (AS).
  • Understanding the long-term implications of CD is essential for managing AS patients effectively.

Purpose of the Study:

  • To investigate the impact of cardiac damage extent on long-term survival in patients with moderate and severe aortic stenosis.
  • To evaluate the effectiveness of aortic valve replacement (AVR) in relation to cardiac damage and AS severity.

Main Methods:

  • Pooled analysis of two single-center registries including patients with moderate or severe AS.
  • Classification of patients based on the presence of early (stages 0-1) or advanced (stages 2-4) cardiac damage.
  • Statistical analysis of 10-year mortality risk and the association of AVR with outcomes, adjusted for AS severity and CD stage.

Main Results:

  • A gradual increase in 10-year mortality risk was observed with increasing AS severity and CD extent.
  • Advanced CD was present in 79.4% of the 626 included patients, with a median follow-up of 7.4 years.
  • Aortic valve replacement (AVR) was associated with significantly lower mortality in patients with advanced CD, irrespective of AS severity, and in severe AS with early CD.

Conclusions:

  • The extent of cardiac damage is a key determinant of 10-year mortality in patients with moderate to severe AS.
  • Aortic valve replacement (AVR) demonstrates a survival benefit, particularly in patients with moderate AS and advanced cardiac damage.
Abstract

Keywords:
aortic stenosisaortic valve replacementcardiac damage

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