title: Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Pereira
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
authors.forename: Mohammad
authors.initials: M
authors.lastname: Bashir
authors.forename: Imran
authors.initials: I
authors.lastname: Afridi
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Craig R
authors.initials: CR
authors.lastname: Asher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality* / Q000601:surgery*