Valve replacement in aortic stenosis with preoperative mean gradient <50 mmHg: Hemodynamic outcome

Joseph L. Blackshear, Fletcher A. Miller, Hassan Loutfi, Sanford J. Finck, Harold E. Snyder, Richard C. Agnew, Thomas A. Orszulak

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Abstract

Background and aims of the study: No prior studies have defined pre- versus postoperative hemodynamics of large numbers of patients with low mean transvalvular gradients. This was our objective. Methods: Retrospective analysis was undertaken of preoperative and postoperative echo/Doppler data in 294 patients who underwent aortic valve replacement (AVR) for aortic stenosis (AS). Some 136 patients had a preoperative mean gradient of <50 mmHg. The relationship of preoperative to pre- minus postoperative (Δ) mean gradient (GRAD), peak valvular velocity (V2), left ventricular outflow tract velocity (V1), V1/V2ratio, V-V1, and aortic valve area (AVA) were plotted and analyzed such that a'zero-benefit threshold' from surgery could be estimated. Results: Strong relationships (r >0.80) were noted for GRAD to ΔGRAD, V2 to ΔV2, and (V2-V1) to Δ(V2-V1) with zero-benefit thresholds of 16 mmHg for GRAD, 2.6 m/s for V2 and 1.7 m/s for V2-V1. These thresholds were lower in patients who received homografts (11 mmHg, 2.2 m/s, and 1.1 m/s respectively), p<0.02. The relationship of pre operative V1/V2 to ΔV1/V2, and AVA-ΔAVA were weaker (r = 0.52 and 0.33 respectively) with zero-benefit thresholds of 0.41 and 2.0 cm2. Among patients with depressed preoperative fractional shortening, improvement was confined to those without coexistent coronary artery disease. Conclusion: This analysis of thresholds of mean gradient benefit suggests that most patients with low gradient AS improve hemodynamically from AVR. The hemodynamic 'break-even' point averages a mean gradient of 16 mmHg.

Original languageEnglish (US)
Pages (from-to)647-655
Number of pages9
JournalJournal of Heart Valve Disease
Volume5
Issue number6
StatePublished - Nov 1 1996

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Blackshear, J. L., Miller, F. A., Loutfi, H., Finck, S. J., Snyder, H. E., Agnew, R. C., & Orszulak, T. A. (1996). Valve replacement in aortic stenosis with preoperative mean gradient <50 mmHg: Hemodynamic outcome. Journal of Heart Valve Disease, 5(6), 647-655.