TY - JOUR
T1 - Poor Survival with Impaired Valvular Hemodynamics After Aortic Valve Replacement
T2 - The National Echo Database Australia Study
AU - NEDA Contributing Sites
AU - Playford, David
AU - Stewart, Simon
AU - Celermajer, David
AU - Prior, David
AU - Scalia, Gregory M.
AU - Marwick, Thomas
AU - Ilton, Marcus
AU - Codde, Jim
AU - Strange, Geoff
N1 - Funding Information:
NEDA was originally established with funding support from Actelion Australia Pharmaceuticals , Bayer Pharmaceuticals , and GlaxoSmithKline . Both NEDA ( 1055214 ) and Dr. Stewart ( 11358940 ) are supported by the National Health and Medical Research Council of Australia .
Funding Information:
NEDA was originally established with funding support from Actelion Australia Pharmaceuticals, Bayer Pharmaceuticals, and GlaxoSmithKline. Both NEDA (1055214) and Dr. Stewart (11358940) are supported by the National Health and Medical Research Council of Australia.
Publisher Copyright:
© 2020 American Society of Echocardiography
PY - 2020/9
Y1 - 2020/9
N2 - Background: There are limited data to describe the relationship between the transvalvular gradient and mortality among patients who undergo aortic valve replacement. Methods: Using the National Echo Database Australia, valvular hemodynamics were characterized in 3,943 men (mean age, 62 ± 18 years) and 2,107 women (mean age, 62 ± 19 years) who underwent aortic valve replacement (median follow-up duration, 770 days; interquartile range, 381–1,584 days). The degree of impaired valvular hemodynamics (IVH) was categorized as mild (mean gradient 10.0–19.9 mm Hg, peak velocity 2.0–2.9 m/sec), moderate (mean gradient 20.0–39.9 mm Hg, peak velocity 3.0–3.9 m/sec), or severe (mean gradient ≥ 40.0 mm Hg, peak velocity ≥ 4 m/sec or effective orifice area < 0.8 cm2). Results: Overall, 2,175 (36.0%), 2,598 (42.9%), 698 (11.5%), and 579 (9.6%) patients had no, mild, moderate, and severe IVH, respectively. Those with residual moderate or severe IVH had 5-year mortality of 45.5% and 57.3%, respectively, and higher adjusted long-term all-cause mortality (adjusted hazard ratios, 1.44 and 2.02; P <.001) compared with “no IVH.” Patients with mild IVH had similar mortality rates to those without IVH. A mortality threshold was evident above a mean transvalvular gradient >22.5 mm Hg after adjusting for age, sex, stroke volume index, aortic regurgitation, and effective orifice area. Conclusions: After aortic valve replacement, most patients displayed an acceptable aortic valve hemodynamic profile. Moderate to severe IVH, however, was associated with poor long-term survival, with a threshold for increased mortality similar to that of native valvular aortic stenosis evident.
AB - Background: There are limited data to describe the relationship between the transvalvular gradient and mortality among patients who undergo aortic valve replacement. Methods: Using the National Echo Database Australia, valvular hemodynamics were characterized in 3,943 men (mean age, 62 ± 18 years) and 2,107 women (mean age, 62 ± 19 years) who underwent aortic valve replacement (median follow-up duration, 770 days; interquartile range, 381–1,584 days). The degree of impaired valvular hemodynamics (IVH) was categorized as mild (mean gradient 10.0–19.9 mm Hg, peak velocity 2.0–2.9 m/sec), moderate (mean gradient 20.0–39.9 mm Hg, peak velocity 3.0–3.9 m/sec), or severe (mean gradient ≥ 40.0 mm Hg, peak velocity ≥ 4 m/sec or effective orifice area < 0.8 cm2). Results: Overall, 2,175 (36.0%), 2,598 (42.9%), 698 (11.5%), and 579 (9.6%) patients had no, mild, moderate, and severe IVH, respectively. Those with residual moderate or severe IVH had 5-year mortality of 45.5% and 57.3%, respectively, and higher adjusted long-term all-cause mortality (adjusted hazard ratios, 1.44 and 2.02; P <.001) compared with “no IVH.” Patients with mild IVH had similar mortality rates to those without IVH. A mortality threshold was evident above a mean transvalvular gradient >22.5 mm Hg after adjusting for age, sex, stroke volume index, aortic regurgitation, and effective orifice area. Conclusions: After aortic valve replacement, most patients displayed an acceptable aortic valve hemodynamic profile. Moderate to severe IVH, however, was associated with poor long-term survival, with a threshold for increased mortality similar to that of native valvular aortic stenosis evident.
KW - Aortic stenosis
KW - Aortic valve replacement
KW - Cohort study
KW - Echocardiography
KW - Hemodynamics
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85086912918&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2020.04.024
DO - 10.1016/j.echo.2020.04.024
M3 - Article
C2 - 32593505
AN - SCOPUS:85086912918
VL - 33
SP - 1077-1086.e1
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
IS - 9
ER -