scholarly journals Long-term outcome of congenital aortic valve stenosis: predictors of reintervention

2014 ◽  
Vol 25 (5) ◽  
pp. 893-902 ◽  
Author(s):  
Léa Hochstrasser ◽  
Patrick Ruchat ◽  
Nicole Sekarski ◽  
Michel Hurni ◽  
Ludwig K. von Segesser
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Post Intervention ◽  
Term Outcome ◽  
Congenital Aortic Stenosis ◽  
Long Term Outcome ◽  
Posterior Wall Thickness

AbstractObjectives:To evaluate long-term outcome of initial aortic valve intervention in a paediatric population with congenital aortic stenosis, and to determine risk factors associated with reintervention.Patients and methods:From 1985 to 2009, 77 patients with congenital aortic stenosis and a mean age of 5.8±5.6 years at diagnosis were followed up in our institution for 14.8±9.1 years.Results:First intervention was successful with 86% of patients having a residual peak aortic gradient <50 mmHg, and the proportion of patients with grade >1 regurgitation increased by 7%. Long-term survival after the first procedure was excellent, with 91% survival at 25 years. At a mean interval of 7.6±5.3 years, 30 patients required a reintervention (39%), mainly because of a recurrent aortic stenosis. Freedom from reintervention was 97, 89, 75, 53, and 42% at 1, 10, 15, 20, and 25 years, respectively. Predictors of reintervention were residual peak aortic gradient (p=0.0001), aortic regurgitation post-intervention >1 (p=0.02), prior balloon aortic valvuloplasty (p=0.04), and increased left ventricular posterior wall thickness (p=0.1).Conclusions:Aortic valve intervention is a safe and effective procedure for congenital aortic stenosis with excellent survival results. However, rate of reintervention is high and influenced by increased left ventricular posterior wall thickness pre-intervention, prior balloon valvuloplasty, higher residual peak systolic valve gradient, and more than mild regurgitation post-intervention. The study highlights that long-term follow-up is recommended for these patients.

P303Prognostic value of diastolic wall strain in patients with asymptomatic severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Suwa ◽  
Y Miyasaka ◽  
N Taniguchi ◽  
S Harada ◽  
I Shiojima
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Wall Thickness ◽  
Severe Aortic Stenosis ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Kaplan Meier ◽  
Posterior Wall Thickness ◽  
Diastolic Wall Strain

Abstract Background Diastolic wall strain (DWS) has been reported to be associated with left ventricular (LV) stiffness and worse clinical outcomes. We sought to assess the utility of this new index for prediction of prognosis in asymptomatic patients with severe aortic stenosis (AS). Methods Asymptomatic severe AS patients [peak flow velocity (PFV) ≥4.0m/s, mean pressure gradient (mPG) ≥40mmHg, aortic valve area (AVA) ≤1.0cm2, or indexed AVA ≤0.6cm2/m2)] diagnosed between July 2007 and April 2016 were included in this study. Patients with significant mitral valve disease, posterior wall motion abnormality, prior cardiac surgery, hypertrophic cardiomyopathy, and LV ejection fraction <50% were excluded. DWS was calculated with a validated formula [DWS = (posterior wall thickness at end-systole − posterior wall thickness at end-diastole)/posterior wall thickness at end-systole]. All study patients were prospectively followed up to last visit or death until November 2017, and predictive value of all-cause death was assessed using Cox-proportional hazards modeling. Patients who underwent aortic valve replacement (AVR) during the study period were censored on the date of surgery. Results A total of 184 asymptomatic severe AS, 138 (age 76±9year-old, men 41%, PFV 3.9±1.0m/s, mPG 38±19mmHg, AVA 0.83±0.18cm2, indexed AVA 0.56±0.13cm2/m2) met all study criteria. Of whom, 43 (31%) underwent AVR and 28 (20%) died during a mean follow-up of 25±28months. In a multivariable model after adjusting for clinical and echocardiographic variables, advancing age (per10yrs; HR=2.19, 95% CI=1.19–4.03, P<0.05), history of hemodialysis (HR=4.31, 95% CI=1.30–14.35, P<0.05), and low-DWS (DWS <0.30) (HR=2.83, 95% CI=1.25–6.40, P<0.05) were independent predictors of all-cause death. In the Kaplan-Meier estimates of cumulative survival stratified by DWS status were shown (Figure). The Kaplan-Meier estimates of survival Conclusion Low-DWS provides prognostic information in patients with asymptomatic severe AS.

scholarly journals Reverse left ventricular remodelling after aortic valve replacement for severe aortic insufficiency

2021 ◽  
Author(s):  
Teppei Toya ◽  
Satsuki Fukushima ◽  
Yusuke Shimahara ◽  
Shingo Kasahara ◽  
Junjiro Kobayashi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Predictive Factors ◽  
Cardiovascular Events ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Lv Function ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lv Mass

Abstract OBJECTIVES The goal of this study was to investigate the long-term outcome of aortic valve replacement (AVR) for severe aortic insufficiency with a focus on pre- and postoperative left ventricular (LV) function to explore predictive factors that influence the recovery of LV function and clinical outcome. METHODS A total of 478 patients who underwent AVR for pure severe aortic insufficiency were grouped according to the preoperative echocardiographical LV ejection fraction (EF): low (LO) EF &lt;35% (n = 43), moderate EF 35–50% (n = 150) or normal EF &gt;50% (n = 285). RESULTS Actuarial survival at 10 years post-AVR was 64% with a LO EF, 92% with a moderate EF and 93% with a normal EF (P = 0.016), whereas 10-year rates of freedom from major adverse cerebral and cardiovascular events were 47%, 79% and 84%, respectively (P &lt; 0.0001). Echocardiography at 1 year post-AVR demonstrated that EF substantially improved in all groups. We noted a significant difference in survival (P = 0.0086) and in freedom from major adverse cerebral and cardiovascular events (P = 0.024) between patients with an EF ≥35% and those with an EF &lt;35% in the LO EF group. The multivariable logistic regression model showed that predictive factors for lack of improvement in EF 1 year post-AVR in the LO EF group included plasma brain natriuretic peptide &gt;365 pg/mL (P = 0.0022) and echocardiographic LV mass index) &gt;193 g/m2 (P = 0.0018). CONCLUSIONS Long-term outcome post-AVR for severe aortic insufficiency was largely influenced by preoperative LV function. Predictive factors of failure to recover ventricular function post-AVR included EF &lt;25%, pre-brain natriuretic peptide &gt;365 pg/mL or LV mass index &gt;193 g/m2.

Long-term Outcome of Cirrhotic Patients With Severe Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation

2015 ◽  
Vol 68 (4) ◽  
pp. 353-354 ◽  
Author(s):  
Isaac Pascual ◽  
Antonio J. Muñoz-García ◽  
Diego López-Otero ◽  
Pablo Avanzas ◽  
Juan H. Alonso-Briales ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Transcatheter Aortic Valve ◽  
Cirrhotic Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation
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