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Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction

Abstract: Introduction and objectives Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. Methods We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. Results We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7?1.4; P=.95). Conclusions There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.

 Fuente: Revista Española de Cardiología 2022

 Editorial: Doyma

 Año de publicación: 2022

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.rec.2022.05.009

 ISSN: 0300-8932,1579-2242,1885-5857

 Url de la publicación: https://doi.org/10.1016/j.rec.2022.05.009

Autoría

HERNÁNDEZ-VAQUERO, DANIEL

RODRÍGUEZ-CAULO, EMILIANO

VIGIL-ESCALERA, CARLOTA

BLANCO-HERRERA, ÓSCAR

BERASATEGUI, ELISABET

ARIAS-DACHARY, JAVIER

SOUAF, SOUHAYLA

PARODY, GERTRUDIS

LAGUNA, GREGORIO

ADSUAR, ALEJANDRO

CASTELLÁ, MANEL

VALDERRAMA, JOSÉ F.

IVANA PULITANI

CÁNOVAS, SERGIO

FERREIRO, ANDREA

GARCÍA-VALENTÍN, ANTONIO

CARNERO, MANUEL

PAREJA, PILAR

CORRALES, JOSÉ A.

BLÁZQUEZ, JOSÉ A.