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Clinical outcomes and impact of aortic valve replacement in concordant vs discordant high-gradient aortic stenosis

Hesham Sheashaa1, Juan M Farina1, Kamal Awad1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ.

American Heart Journal
|June 6, 2026
PubMed

Insights

Survival outcomes in discordant high-gradient aortic stenosis (DHG-AS) are similar to concordant cases after accounting for aortic valve replacement (AVR). Aortic valve replacement significantly improves survival for DHG-AS patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes Research

Background:

  • Conflicting data exists on clinical outcomes for discordant high-gradient aortic stenosis (DHG-AS).
  • Limited information is available on the impact of aortic valve replacement (AVR) in DHG-AS patients.

Purpose of the Study:

  • To compare clinical outcomes between concordant (CHG-AS) and discordant (DHG-AS) high-gradient aortic stenosis.
  • To evaluate the impact of AVR on mortality in DHG-AS patients.

Main Methods:

  • Analysis of 14,640 patients with high-gradient aortic stenosis, categorized as CHG-AS or DHG-AS based on aortic valve area indexed to body surface area.
  • Propensity score matching (1:1) to adjust for demographics and comorbidities.
  • Kaplan-Meier curves and Cox proportional hazards models used to compare mortality and AVR rates; competing-risk methods and time-dependent covariates employed for AVR analysis.

Main Results:

  • After propensity score matching, 958 patients were in each group (CHG-AS vs. DHG-AS).
  • DHG-AS patients had lower AVR rates (SHR 0.56).
  • Ten-year mortality was not significantly different between DHG-AS and CHG-AS after adjusting for AVR. In DHG-AS patients, AVR reduced 10-year mortality (HR 0.538).

Conclusions:

  • Survival outcomes do not significantly differ between DHG-AS and CHG-AS when AVR is considered.
  • Aortic valve replacement is associated with improved survival in DHG-AS patients.
  • Timely AVR intervention is supported for DHG-AS.
Abstract

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