title: Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosis.
abstract: OBJECTIVE
  To identify predictors of survival following aortic valve replacement (AVR) in patients with low-flow and high-gradient aortic stenosis (AS).
  
  
  RESULTS
  Eighty-six patients (aged 71 +/- 10 years) with severe AS [aortic valve mean pressure gradient >40 mmHg or valve area <1.0 cm(2)] and left ventricular (LV) dysfunction [ejection fraction (EF) <50%] underwent AVR. Cox proportional hazards were used to identify independent clinical and echocardiographic predictors of mortality. Operative (30-day) mortality was 10%. Peri-operative mortality was associated with lower mean LVEF, higher mitral E:A ratio, peak systolic pulmonary artery pressure (PSPAP), and serum creatinine (by 12%, 2.3, 28 mmHg, and 74 mmol/L, respectively, all P < 0.001), NYHA class III-IV (100 vs. 65%), concomitant CABG (89 vs. 55%), urgent surgery (78 vs. 35%), and longer bypass-time (by 28 min, all P < 0.05). Mortality at 4 years was 17%. Univariate predictors [hazard ratio (HR)] of 4-year mortality were: lower EF (HR 0.68 per % increase, P < 0.001), presence of restrictive LV filling (HR: 3.52, P < 0.001), raised PSPAP (HR: 1.07, P < 0.001), and CABG (HR: 4.93, P = 0.037). However, only low EF (<40%, HR 0.74, P = 0.030), the presence of restrictive filling (HR 1.77, P = 0.033), and raised PSPAP (>45 mmHg, HR 2.71, P = 0.010) remained as independent predictors after multivariate analysis.
  
  
  CONCLUSIONS
  The severity of pre-operative systolic and diastolic LV dysfunction is the major predictor of mortality following AVR for low-flow and high-gradient AS.
authors: Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China.
authors: Wen-Hong
authors: WH
authors: Ding
authors: Yat-Yin
authors: YY
authors: Lam
authors: Alison
authors: A
authors: Duncan
authors: Wei
authors: W
authors: Li
authors: Eric
authors: E
authors: Lim
authors: Mehmet G
authors: MG
authors: Kaya
authors: Robin
authors: R
authors: Chung
authors: John R
authors: JR
authors: Pepper
authors: Michael Y
authors: MY
authors: Henein
mesh_terms: D000368:Aged; D001020:Aortic Stenosis, Subvalvular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D021921:Aortic Stenosis, Supravalvular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D001026:Coronary Artery Bypass; D005260:Female; D006305:Health Status Indicators; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D016277:Ventricular Function, Left