Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction

Zainab Samad, Amit N. Vora, Allison Dunning, Phillip Schulte, Linda K. Shaw, Fawaz Al-Enezi, Mads Ersboll, Robert W. McGarrah, John P. Vavalle, Svati H. Shah, Joseph Kisslo, Donald Glower, J. Kevin Harrison, Eric J. Velazquez

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Aims We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. Methods and results The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. Conclusions In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.

Original languageEnglish (US)
Pages (from-to)2276-2286
Number of pages11
JournalEuropean Heart Journal
Volume37
Issue number28
DOIs
StatePublished - Jul 21 2016
Externally publishedYes

Fingerprint

Aortic Valve Stenosis
Left Ventricular Dysfunction
Aortic Valve
Survival
Coronary Artery Bypass
Mortality
Proportional Hazards Models
Stroke Volume
Databases

Keywords

  • aortic valve surgery
  • left ventricular systolic dysfunction
  • Moderate aortic stenosis
  • severe aortic stenosis
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction. / Samad, Zainab; Vora, Amit N.; Dunning, Allison; Schulte, Phillip; Shaw, Linda K.; Al-Enezi, Fawaz; Ersboll, Mads; McGarrah, Robert W.; Vavalle, John P.; Shah, Svati H.; Kisslo, Joseph; Glower, Donald; Harrison, J. Kevin; Velazquez, Eric J.

In: European Heart Journal, Vol. 37, No. 28, 21.07.2016, p. 2276-2286.

Research output: Contribution to journalArticle

Samad, Z, Vora, AN, Dunning, A, Schulte, P, Shaw, LK, Al-Enezi, F, Ersboll, M, McGarrah, RW, Vavalle, JP, Shah, SH, Kisslo, J, Glower, D, Harrison, JK & Velazquez, EJ 2016, 'Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction', European Heart Journal, vol. 37, no. 28, pp. 2276-2286. https://doi.org/10.1093/eurheartj/ehv701
Samad, Zainab ; Vora, Amit N. ; Dunning, Allison ; Schulte, Phillip ; Shaw, Linda K. ; Al-Enezi, Fawaz ; Ersboll, Mads ; McGarrah, Robert W. ; Vavalle, John P. ; Shah, Svati H. ; Kisslo, Joseph ; Glower, Donald ; Harrison, J. Kevin ; Velazquez, Eric J. / Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction. In: European Heart Journal. 2016 ; Vol. 37, No. 28. pp. 2276-2286.
@article{1b3b215fa68a49b7a594f24957b32233,
title = "Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction",
abstract = "Aims We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. Methods and results The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50{\%}) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67{\%}) or severe (N = 544, 33{\%}) AS by mean gradient criteria. Overall, 287 (26{\%}) patients with moderate AS and 263 (48{\%}) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53{\%}) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. Conclusions In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.",
keywords = "aortic valve surgery, left ventricular systolic dysfunction, Moderate aortic stenosis, severe aortic stenosis, survival",
author = "Zainab Samad and Vora, {Amit N.} and Allison Dunning and Phillip Schulte and Shaw, {Linda K.} and Fawaz Al-Enezi and Mads Ersboll and McGarrah, {Robert W.} and Vavalle, {John P.} and Shah, {Svati H.} and Joseph Kisslo and Donald Glower and Harrison, {J. Kevin} and Velazquez, {Eric J.}",
year = "2016",
month = "7",
day = "21",
doi = "10.1093/eurheartj/ehv701",
language = "English (US)",
volume = "37",
pages = "2276--2286",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "28",

}

TY - JOUR

T1 - Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction

AU - Samad, Zainab

AU - Vora, Amit N.

AU - Dunning, Allison

AU - Schulte, Phillip

AU - Shaw, Linda K.

AU - Al-Enezi, Fawaz

AU - Ersboll, Mads

AU - McGarrah, Robert W.

AU - Vavalle, John P.

AU - Shah, Svati H.

AU - Kisslo, Joseph

AU - Glower, Donald

AU - Harrison, J. Kevin

AU - Velazquez, Eric J.

PY - 2016/7/21

Y1 - 2016/7/21

N2 - Aims We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. Methods and results The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. Conclusions In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.

AB - Aims We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. Methods and results The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. Conclusions In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.

KW - aortic valve surgery

KW - left ventricular systolic dysfunction

KW - Moderate aortic stenosis

KW - severe aortic stenosis

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=84991709733&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991709733&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehv701

DO - 10.1093/eurheartj/ehv701

M3 - Article

C2 - 26787441

AN - SCOPUS:84991709733

VL - 37

SP - 2276

EP - 2286

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 28

ER -