Kang, Duk-Hyun; Jang, Jeong Yoon; Park, Sung-Ji; Kim, Dae-Hee; Yun, Sung-Cheol; Song, Jong-Min; Park, Seung Woo; Chung, Cheol-Hyun; Song, Jae-Kwan; Lee, Jae-Won
Heart (British Cardiac Society)
2015Sep ; 101 ( 17 ) :1375-81.
PMID : 26105038
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Kang, Duk-Hyun - Division of Cardiology, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Jang, Jeong Yoon - Division of Cardiology, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Park, Sung-Ji - Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim, Dae-Hee - Division of Cardiology, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Yun, Sung-Cheol - Division of Biostatistics, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Song, Jong-Min - Division of Cardiology, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Park, Seung Woo - Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Chung, Cheol-Hyun - Division of Cardiac Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Song, Jae-Kwan - Division of Cardiology, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Lee, Jae-Won - Division of Cardiac Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
ABSTRACT
OBJECTIVES: The timing of aortic valve replacement (AVR) remains controversial in symptomatic patients with normal flow, low-gradient severe aortic stenosis (AS) and preserved LVEF. We sought to compare long-term mortality of early AVR versus a watchful observation strategy.
METHODS: From 2000 to 2011, we prospectively evaluated 284 consecutive symptomatic patients (136 men, age 68±10?years) with normal flow, low-gradient severe AS and preserved LVEF who were potential candidates for early AVR. Normal flow, low-gradient severe AS was defined as indexed aortic valve area <0.6?cm(2)/m(2) with mean gradient <40?mm?Hg and stroke volume index ??5?mL/m(2). Early AVR was performed on 98 patients (early AVR group), while the watchful observation strategy was selected for 186 patients (watchful observation group). Patients in the watchful observation group were referred for AVR if mean gradient was ??0?mm?Hg during follow-up.
RESULTS: There were no significant differences between the early AVR and the watchful observation groups for the risk of overall mortality (HR 0.94 for the early AVR; 95% CI 0.51 to 1.73) or for the estimated actuarial 8-year mortality rates (17±5% vs 27±5%, p=0.84) in the overall cohort. Society of Thoracic Surgeons score, comorbidity index, age, coronary artery disease, aetiology of AS and performance of AVR were associated with overall survival. For 83 propensity-score-matched pairs, the risk of overall death was not significantly different between the two groups (HR 1.13 for the early AVR, 95% CI 0.55 to 2.35, p=0.74).
CONCLUSIONS: Early AVR and watchful observation strategy show similar survival in symptomatic patients with normal flow, low-gradient severe AS and preserved LVEF. Watchful observation with timely performance of AVR should be considered a therapeutic option. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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MESH
Aged, Aortic Valve Stenosis/complications/diagnosis/mortality/physiopathology/*surgery, Echocardiography, Doppler, Female, *Heart Valve Prosthesis Implantation/adverse effects/mortality, *Hemodynamics, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Patient Selection, Propensity Score, Proportional Hazards Models, Prospective Studies, Registries, Risk Factors, Severity of Illness Index, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, *Watchful Waiting
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