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Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunctionOBJECTIVE: We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low transvalvular gradient (TVG) is associated with improved survival. BACKGROUND: The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial. METHODS: Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group. RESULTS: Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level. CONCLUSIONS: Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.
Document ID
Document Type
Reprint (Version printed in journal)
Pereira, Jeremy J. (Cleveland Clinic Foundation Cleveland, Ohio 44195, United States)
Lauer, Michael S.
Bashir, Mohammad
Afridi, Imran
Blackstone, Eugene H.
Stewart, William J.
McCarthy, Patrick M.
Thomas, James D.
Asher, Craig R.
Date Acquired
August 21, 2013
Publication Date
April 17, 2002
Publication Information
Publication: Journal of the American College of Cardiology
Volume: 39
Issue: 8
ISSN: 0735-1097
Subject Category
Life Sciences (General)
Funding Number(s)
Distribution Limits
NASA Discipline Cardiopulmonary
Evaluation Studies
Non-NASA Center