OC04 BASELINE ATRIAL STRAIN RELATES TO POST-SURGICAL FOLLOW UP IN SEVERE AORTIC STENOSIS

Background: The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. Method and Results: From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18–29] mm Hg vs. 21 [16–29] mm Hg and 18 [14–24] mm Hg, p < 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank p value = 0.04) in conventional, Perceval®, and Intuity® groups. Conclusions: We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.

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Natural Progression of Low-Gradient Severe Aortic Stenosis with Preserved Ejection Fraction

Texas Heart Institute Journal ◽

10.14503/thij-13-3167 ◽

2014 ◽

Vol 41 (3) ◽

pp. 273-279 ◽

Cited By ~ 2

Author(s):

Antony Leslie Innasimuthu ◽

Sanjay Kumar ◽

Jason Lazar ◽

William E. Katz

Keyword(s):

Aortic Stenosis ◽

Ejection Fraction ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Aortic Valve Area ◽

Ventricular Ejection Fraction ◽

Mild Stenosis ◽

Natural Progression

Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371–1,020 d). All patients had preserved left ventricular ejection fraction (>0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm2), moderate stenosis (≥1 to <1.5 cm2), or severe stenosis (<1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean <40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up.

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Mortality in low-risk patients with aortic stenosis undergoing transcatheter or surgical aortic valve replacement: a reconstructed individual patient data meta-analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa179 ◽

2020 ◽

Vol 31 (5) ◽

pp. 587-594

Author(s):

Mevlüt Çelik ◽

Milan M Milojevic ◽

Andras P Durko ◽

Frans B S Oei ◽

Ad J J C Bogers ◽

...

Keyword(s):

Data Analysis ◽

Aortic Stenosis ◽

Individual Patient Data ◽

Severe Aortic Stenosis ◽

Mortality Rates ◽

Patient Data ◽

Low Risk ◽

All Cause Mortality ◽

Risk Patients

Abstract OBJECTIVES Although the standard of care for patients with severe aortic stenosis at low-surgical risk has included surgical aortic valve replacement (SAVR) since the mid-1960s, many clinical studies have investigated whether transcatheter aortic valve implantation (TAVI) can be a better approach in these patients. As no individual study has been performed to detect the difference in mortality between these 2 treatment strategies, we did a reconstructive individual patient data analysis to study the long-term difference in all-cause mortality. METHODS Randomized clinical trials and propensity score-matched studies that included low-risk adult patients with severe aortic stenosis undergoing either SAVR or TAVI and with reports on the mortality rates during the follow-up period were considered. The primary outcome was all-cause mortality of up to 5 years. RESULTS In the reconstructed individual patient data analysis, there was no statistically significant difference in all-cause mortality between TAVI and SAVR at 5 years of follow-up [30.7% vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.96–1.48; P = 0.104]. However, landmark analyses in patients surviving up to 1 year of follow-up showed significantly higher all-cause mortality at 5 years of follow-up (27.5% vs 17.3%, HR 1.77, 95% CI 1.29–2.43; P < 0.001) in patients undergoing TAVI compared to patients undergoing SAVR, respectively. CONCLUSIONS This reconstructed individual patient data analysis in low-risk patients with severe aortic stenosis demonstrates that the 5-year all-cause mortality rates are higher after TAVI than after SAVR, driven by markedly higher mortality rates between 1 and 5 years of follow-up in the TAVI group. The present results call for caution in expanding the TAVI procedure as the treatment of choice for the majority of all low-risk patients until long-term data from contemporary randomized clinical trials are available.

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PO621 Heart Rate Reduction Wiht Ivabradine In Severe Aortic Stenosis Rejected to Valve Replacement. Long Term Follow Up

Global Heart ◽

10.1016/j.gheart.2018.09.480 ◽

2018 ◽

Vol 13 (4) ◽

pp. 513

Author(s):

G.A. Cortez Quiroga ◽

M.C. Durán Torralba ◽

C. Rus Mansilla ◽

D. Fatela Cantillo ◽

A. Fernández Suárez

Keyword(s):

Heart Rate ◽

Aortic Stenosis ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Heart Rate Reduction ◽

Rate Reduction ◽

Long Term Follow Up

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Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.605257 ◽

2020 ◽

Vol 7 ◽

Author(s):

Silvia Mas-Peiro ◽

Philipp C. Seppelt ◽

Roberta De Rosa ◽

Marie-Isabel Murray ◽

Jörg Yogarajah ◽

...

Keyword(s):

Aortic Stenosis ◽

Prognostic Value ◽

Severe Aortic Stenosis ◽

Strong Predictor ◽

Nyha Class ◽

High Volume ◽

Class Iii ◽

Eligibility Criteria ◽

Term Survival

Background: Both EPO levels and anemia have shown prognostic value in several cardiac disorders. An observational study with a prospective follow-up was performed to investigate their independent prognostic roles in severe aortic stenosis.Methods: An up to 36-month follow-up of consecutive patients with severe aortic stenosis undergoing TAVR in a high-volume center was performed. Patients with eGRF <30 mL/min/1.73 m2 were excluded. EPO levels and/or anemia status and its association with mid-term mortality were assessed.Results: Out of 407, 360 met eligibility criteria. Median age was 83 years, with 71.4% having a NYHA class III/IV. Anemia was present in 51.9%, and iron deficiency in 52.8%. Median (IQR) EPO levels were 14.4 (9.30–24.30) mIU/mL. Median follow-up was 566 days. Anemia was associated with overall mortality (HR 2.40, 95% CI 1.51–3.80, p < 0.001). Higher logEPO levels were associated with mid-term mortality (HR 4.05, 95% CI 2.29–7.16, p < 0.001), even after adjusting for clinically and/or statistically relevant factors (multivariate HR 2.25, 95 CI 1.09–4.66, p = 0.029). Kaplan-Meier analyses showed early diverging curves for anemia vs. non-anemia, whereas curves for patients in various EPO level quartiles started to diverge at about 100 days, with differences consistently increasing during the subsequent entire follow-up period.Conclusions: Differently from anemia, which was a strong predictor for both early and late mortality in severe aortic stenosis after TAVR, independent prognostic value of EPO only emerged after post-TAVR recovery. EPO prognostic value was independent from anemia and mild-to-moderate renal dysfunction. High EPO levels could be useful to identify patients with severe aortic stenosis showing a compromised mid-term survival in spite of TAVR use and independently from early TAVR results.

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Long-term outcomes of the Ross procedure in adults with severe aortic stenosis: single-centre experience with 20 years of follow-up†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezu038 ◽

2014 ◽

Vol 47 (1) ◽

pp. 159-167 ◽

Cited By ~ 17

Author(s):

David Kalfa ◽

Siamak Mohammadi ◽

Dimitri Kalavrouziotis ◽

Mounir Kharroubi ◽

Daniel Doyle ◽

...

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Ross Procedure ◽

Long Term Outcomes ◽

Single Centre ◽

Single Centre Experience

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Exercise testing in patients with asymptomatic moderate or severe aortic stenosis

Heart ◽

10.1136/heartjnl-2018-312939 ◽

2018 ◽

Vol 104 (22) ◽

pp. 1836-1842 ◽

Cited By ~ 24

Author(s):

Sahrai Saeed ◽

Ronak Rajani ◽

Reinhard Seifert ◽

Denise Parkin ◽

John Boyd Chambers

Keyword(s):

Aortic Stenosis ◽

Exercise Testing ◽

Severe Aortic Stenosis ◽

Prognostic Information ◽

Exercise Tests ◽

Serious Adverse Events ◽

Asymptomatic Patients ◽

All Cause Mortality ◽

Exercise Treadmill

ObjectiveTo assess the safety and tolerability of treadmill exercise testing and the association of revealed symptoms with outcome in apparently asymptomatic patients with moderate to severe aortic stenosis (AS).MethodsA retrospective cohort study of 316 patients (age 65±12 years, 67% men) with moderate and severe AS who underwent echocardiography and modified Bruce exercise treadmill tests (ETTs) at a specialist valve clinic. The outcome measures were aortic valve replacement (AVR), all-cause mortality or a composite of AVR and all-cause mortality.ResultsAt baseline, there were 210 (66%) patients with moderate and 106 (34%) with severe AS. There were 264 (83%) events. 234 (74%) patients reached an indication for AVR, 145 (69%) with moderate and 88 (83%) with severe AS (p<0.05). Of the 30 (9%) deaths recoded during follow-up, 20 (67%) were cardiovascular related. In total, 797 exercise tests (mean 2.5±2.1 per patient) were performed. No serious adverse events were observed. The prevalence of revealed symptoms at baseline ETT was 29% (n=91) and was significantly higher in severe AS compared with moderate AS (38%vs23%, p=0.008). Symptoms were revealed in 18%–59% of patients during serial ETT conducted over a follow-up period of 34.9 (SD 35.1) months. The event-free survival at 24 months with revealed symptoms was 46%±4% and without revealed symptoms was 70%±4%.ConclusionsETT in patients with moderate or severe AS is safe and tolerable. Serial exercise testing is useful to reveal symptoms not volunteered on the history and adds incremental prognostic information to baseline testing.

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