Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction

Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricu...

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Published in:Revista española de cardiología (English ed.) 2023-01, Vol.76 (1), p.32-39
Main Authors: Hernández-Vaquero, Daniel, Rodríguez-Caulo, Emiliano, Vigil-Escalera, Carlota, Blanco-Herrera, Óscar, Berastegui, Elisabet, Arias-Dachary, Javier, Souaf, Souhayla, Parody, Gertrudis, Laguna, Gregorio, Adsuar, Alejandro, Castellá, Manel, Valderrama, José F., Pulitani, Ivana, Cánovas, Sergio, Ferreiro, Andrea, García-Valentín, Antonio, Carnero, Manuel, Pareja, Pilar, Corrales, José A., Blázquez, José A., Macías, Diego, Fletcher-Sanfeliu, Delfina, Martínez, Daniel, Martín, Elio, Martín, Miren, Margarit, Juan, Hernández-Estefanía, Rafael, Monguió, Emilio, Otero, Juan, Silva, Jacobo
Format: Article
Language:eng ; spa
Subjects:
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic valve replacement
Aortic Valve Stenosis - diagnosis
Aortic Valve Stenosis - surgery
Esperanza de vida
Estenosis aórtica grave
Heart Valve Prosthesis Implantation
Humans
Life Expectancy
Prognosis
Recambio valvular aórtico
Retrospective Studies
Severe aortic stenosis
Severity of Illness Index
Stroke Volume
Treatment Outcome
Ventricular Function, Left
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Summary:Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7–1.4; P=.95). There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups. El recambio valvular aórtico (RVAo) quirúrgico puede modificar la historia natural de la estenosis aórtica grave (EAoG). Sin embargo, comparado con la población general, estos pacientes tienen una pérdida en su esperanza de vida. La esperanza de vida de los pacientes intervenidos de RVAo debido a EAoG de bajo gradiente con fracción de eyección del ventrículo izquierdo (FEVI) conservada se desconoce. Se incluyó a todos los pacientes entre 50 y 65 años sometidos a RVAo quirúrgico aislado en 27 centros durante 18 años. Analizamos la supervivencia observada y esperada a los 18 años de pacientes con EAoG de bajo gradiente con FEVI conservada y todos los otros tipos de EAoG. Mediante emparejamiento basado en índice de propensión, comparamos la esperanza de vida de los pacientes con EAoG de bajo gradiente con FEVI conservada vs EAoG de alto gradiente con FEVI conservada. Se analizó a 5.084 pacientes, 413
ISSN:1885-5857
1885-5857
DOI:10.1016/j.rec.2022.05.009