title: Valve replacement for severe aortic stenosis with low transvalvular gradient and left ventricular ejection fraction exceeding 0.50.
abstract: BACKGROUND
  Severe aortic stenosis with a low transvalvular gradient and preserved left ventricular ejection fraction (LVEF) is often misdiagnosed, leading to undertreatment of such patients with no clear indication for surgical intervention. This study investigated the outcome of aortic valve replacement (AVR) in patients with severe aortic stenosis and a low transvalvular gradient despite normal LVEF.
  
  
  METHODS
  Between 1985 and 2008, we evaluated 73 patients who underwent AVR compared with 29 patients who did not. Overall, aortic valve area was 1.0 cm2 or smaller, LVEF was 0.50 or higher, and transvalvular gradient was 30 mm Hg or less. Multivariate and Cox analyses were used to compare these two groups according to AVR.
  
  
  RESULTS
  Compared with controls, AVR patients were younger and with higher body mass index. Coronary artery bypass grafting was performed simultaneously in 38 AVR patients (52%). At follow-up (median, 42 months; interquartile range, 23 to 75 months), survival was longer in AVR patients. By Cox analysis, AVR remained a major predictor of lower mortality (hazard ratio, 0.237; 95% confidence interval, 0.119 to 0.470; p<0.0001).
  
  
  CONCLUSIONS
  In patients with severe aortic stenosis and low transvalvular gradient despite a normal LVEF, AVR was associated with significant improvement in long-term survival and functional status and with a low operative mortality.
authors.affiliation: Section of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, University Hospital, Pauda, Italy. giuseppe.tarantini.1@unipd.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Elisa
authors.initials: E
authors.lastname: Covolo
authors.forename: Renato
authors.initials: R
authors.lastname: Razzolini
authors.forename: Claudio
authors.initials: C
authors.lastname: Bilato
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Enrico
authors.initials: E
authors.lastname: Favaretto
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D013318:Stroke Volume; D016277:Ventricular Function, Left