- Email: [email protected]
IMPACT OF STROKE VOLUME RECOVERY ON LONG-TERM MORTALITY AFTER SURGICAL AORTIC VALVE REPLACEMENT
S236
Canadian Journal of Cardiology Volume 32 2016
operative mortality following surgical aortic valve replacement (SAVR). It has been demonstrated that left ventricular stroke volume index (SVi) before SAVR (SViP) is an independent predictor of short-term mortality. However, long-term predictors of mortality in this cohort of patients remain to be determined. The objective of this study was to assess the impact of postoperative SVi at discharge (SViD) on long-term survival and echocardiographic parameters in patients with AS and preserved LVEF. METHODS: Among 2171 patients undergoing aortic valve replacement (AVR), we examined 1524 patients with AS and normal LVEF. Six hundred forty-seven patients were excluded: 154 had no post-operative echocardiography, 187 due to technically limited echocardiography and 306 with LVEF <50%. RESULTS: Our cohort consists of 799 patients (52%) with isolated AVR and 725 patients (48%) with AVR + CABG. Five hundred and two patients (33%) were in PLF as defined by SVi of 35 mL/m2before SAVR; and 1022 (67%) were in normal flow (NF) as defined by SVi of >35 mL/m2 before SAVR. Groups were subdivided into 4 according to SViP and SViD: 363 (24%) had PLF and low SViD (Persisting Low Flow [LF]); 129 (9%) had PLF and normal SViD (Normalized Flow); 597 (39%) had NF and low SViD (New onset LF); and 435 (28%) had NF and normal SViD (Maintained NF). One hundred sixty-nine deaths (11%) occurred at a mean followup of 2.9 years. After comprehensive adjustment, mortality rates were significantly higher in the group with persisting LF (HR 1.33, 95% CI: 1.11-1.56, p¼0.047) when compared to the other groups (Table). Patients with persisting LF have lower SVi at 1 year (- 3.83 0.89 mL/m2, p¼0.017) and last follow-up (-5.83 0.87 mL/m2, p<0.001). CONCLUSION: Patients with PLF AS undergoing SAVR and not exhibiting immediate recovery of SVi after surgery have higher rates of long-term mortality. These findings suggest that patients with PLF AS should be considered for early referral to SAVR, as this could prevent the worsening of ventricular dysfunction and adverse outcomes, including mortality. 298 IMPACT OF STROKE VOLUME RECOVERY ON LONG-TERM MORTALITY AFTER SURGICAL AORTIC VALVE REPLACEMENT
Multivariate analysis of overall survival Predictors of mortality
Multivariate analysis HR
95% CI
P Value
5.93
5.59 - 6.28
<0.001
A Poulin, M Berthelot-Richer, L Tastet, L Simard, D Kalavrouziotis, P Pibarot, M Clavel
Age
Québec, Québec
NYHA functional class III-IV
2.07
1.70 - 2.44
0.008
Persisting LF
1.33
1.11 - 1.56
0.047
SVi
0.98
0.95 - 0.99
0.009
BACKGROUND:
In patients with aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), those with paradoxical low flow (PLF) AS have a higher 30-day post-
Chronic kidney disease
4.77
4.51 - 5.04
<0.001
Diabetes
2.30
2.23 - 2.37
0.005
NYHA = New York Heart Association. LF = Low Flow. SVi = Index stroke volume. Adjusted for age, sex, NYHA functional class III or IV, chronic kidney disease, diabetes, coronary artery disease, chronic obstructive pulmonary disease and LVEF.
Canadian Journal of Cardiology Volume 32 2016
operative mortality following surgical aortic valve replacement (SAVR). It has been demonstrated that left ventricular stroke volume index (SVi) before SAVR (SViP) is an independent predictor of short-term mortality. However, long-term predictors of mortality in this cohort of patients remain to be determined. The objective of this study was to assess the impact of postoperative SVi at discharge (SViD) on long-term survival and echocardiographic parameters in patients with AS and preserved LVEF. METHODS: Among 2171 patients undergoing aortic valve replacement (AVR), we examined 1524 patients with AS and normal LVEF. Six hundred forty-seven patients were excluded: 154 had no post-operative echocardiography, 187 due to technically limited echocardiography and 306 with LVEF <50%. RESULTS: Our cohort consists of 799 patients (52%) with isolated AVR and 725 patients (48%) with AVR + CABG. Five hundred and two patients (33%) were in PLF as defined by SVi of 35 mL/m2before SAVR; and 1022 (67%) were in normal flow (NF) as defined by SVi of >35 mL/m2 before SAVR. Groups were subdivided into 4 according to SViP and SViD: 363 (24%) had PLF and low SViD (Persisting Low Flow [LF]); 129 (9%) had PLF and normal SViD (Normalized Flow); 597 (39%) had NF and low SViD (New onset LF); and 435 (28%) had NF and normal SViD (Maintained NF). One hundred sixty-nine deaths (11%) occurred at a mean followup of 2.9 years. After comprehensive adjustment, mortality rates were significantly higher in the group with persisting LF (HR 1.33, 95% CI: 1.11-1.56, p¼0.047) when compared to the other groups (Table). Patients with persisting LF have lower SVi at 1 year (- 3.83 0.89 mL/m2, p¼0.017) and last follow-up (-5.83 0.87 mL/m2, p<0.001). CONCLUSION: Patients with PLF AS undergoing SAVR and not exhibiting immediate recovery of SVi after surgery have higher rates of long-term mortality. These findings suggest that patients with PLF AS should be considered for early referral to SAVR, as this could prevent the worsening of ventricular dysfunction and adverse outcomes, including mortality. 298 IMPACT OF STROKE VOLUME RECOVERY ON LONG-TERM MORTALITY AFTER SURGICAL AORTIC VALVE REPLACEMENT
Multivariate analysis of overall survival Predictors of mortality
Multivariate analysis HR
95% CI
P Value
5.93
5.59 - 6.28
<0.001
A Poulin, M Berthelot-Richer, L Tastet, L Simard, D Kalavrouziotis, P Pibarot, M Clavel
Age
Québec, Québec
NYHA functional class III-IV
2.07
1.70 - 2.44
0.008
Persisting LF
1.33
1.11 - 1.56
0.047
SVi
0.98
0.95 - 0.99
0.009
BACKGROUND:
In patients with aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), those with paradoxical low flow (PLF) AS have a higher 30-day post-
Chronic kidney disease
4.77
4.51 - 5.04
<0.001
Diabetes
2.30
2.23 - 2.37
0.005
NYHA = New York Heart Association. LF = Low Flow. SVi = Index stroke volume. Adjusted for age, sex, NYHA functional class III or IV, chronic kidney disease, diabetes, coronary artery disease, chronic obstructive pulmonary disease and LVEF.