Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly?

Minako Katayama, Mohammad Q. Najib, Punnaiah C. Marella, M'hamed H. Temkit, Marek Belohlavek, Hari P Chaliki

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods: We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was allcause of death. Survival curves were calculated according to Kaplan-Meier method. Results: Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e0 and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions: Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.

Original languageEnglish (US)
Article numbere000241
JournalOpen Heart
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Aortic Valve Stenosis
Electric Impedance
Aortic Valve
Survival
Chronic Renal Insufficiency
Atrial Fibrillation
Hypertension
Tricuspid Valve
Aortic Valve Insufficiency
Survival Analysis
Mitral Valve
Proportional Hazards Models
Surgical Instruments
Coronary Artery Bypass
Thoracic Surgery
Multivariate Analysis
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly? / Katayama, Minako; Najib, Mohammad Q.; Marella, Punnaiah C.; Temkit, M'hamed H.; Belohlavek, Marek; Chaliki, Hari P.

In: Open Heart, Vol. 2, No. 1, e000241, 01.01.2015.

Research output: Contribution to journalArticle

Katayama, Minako ; Najib, Mohammad Q. ; Marella, Punnaiah C. ; Temkit, M'hamed H. ; Belohlavek, Marek ; Chaliki, Hari P. / Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly?. In: Open Heart. 2015 ; Vol. 2, No. 1.
@article{a29d4a89ad574318958f06135f1f7ba3,
title = "Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly?",
abstract = "Background: Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods: We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50{\%}, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was allcause of death. Survival curves were calculated according to Kaplan-Meier method. Results: Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e0 and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70{\%} in low Zva and 81{\%} in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions: Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.",
author = "Minako Katayama and Najib, {Mohammad Q.} and Marella, {Punnaiah C.} and Temkit, {M'hamed H.} and Marek Belohlavek and Chaliki, {Hari P}",
year = "2015",
month = "1",
day = "1",
doi = "10.1136/openhrt-2015-000241",
language = "English (US)",
volume = "2",
journal = "Open Heart",
issn = "2053-3624",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - Does valvuloarterial impedance impact prognosis after surgery for severe aortic stenosis in the elderly?

AU - Katayama, Minako

AU - Najib, Mohammad Q.

AU - Marella, Punnaiah C.

AU - Temkit, M'hamed H.

AU - Belohlavek, Marek

AU - Chaliki, Hari P

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods: We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was allcause of death. Survival curves were calculated according to Kaplan-Meier method. Results: Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e0 and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions: Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.

AB - Background: Valvuloarterial impedance (Zva) was introduced as a prognostic measure in patients with aortic stenosis (AS). However, it is unclear whether Zva has a prognostic impact on survival after surgical aortic valve replacement (AVR) in patients with severe AS with preserved ejection fraction (EF). Methods: We retrospectively reviewed 929 consecutive patients who had AVR. We investigated 170 elderly patients (age >65 years, mean 76 years) who had AVR secondary to severe AS (mean gradient ≥40 mm Hg; aortic valve area ≤1 cm2; peak velocity ≥4 m/s). Patients with EF <50%, greater than moderate aortic regurgitation, prior heart surgery and concomitant mitral or tricuspid valve surgery were excluded. Zva was calculated and the patients were divided into two groups; low Zva, Zva <4.3 (n=82) and high Zva, Zva ≥4.3 (n=88). The end point was allcause of death. Survival curves were calculated according to Kaplan-Meier method. Results: Age, prevalence of hypertension, diabetes, chronic kidney disease (CKD), atrial fibrillation, symptoms, EF, E/e0 and concomitant coronary artery bypass graft were not different between the groups. Survival was not different between the groups at 5 years (70% in low Zva and 81% in high Zva; p=0.21) and for the entire follow-up period (p=0.23). Only age was a significant factor in predicting survival by multivariate analyses in Cox proportional hazards model after adjusting for Zva, CKD, atrial fibrillation and hypertension. Conclusions: Our results suggest that preoperative Zva does not have a prognostic impact on postoperative survival in elderly patients with severe AS with preserved EF. Further investigation is needed to elucidate the controversial results.

UR - http://www.scopus.com/inward/record.url?scp=85049120677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049120677&partnerID=8YFLogxK

U2 - 10.1136/openhrt-2015-000241

DO - 10.1136/openhrt-2015-000241

M3 - Article

AN - SCOPUS:85049120677

VL - 2

JO - Open Heart

JF - Open Heart

SN - 2053-3624

IS - 1

M1 - e000241

ER -