Korean Circ J.  2023 Nov;53(11):744-755. 10.4070/kcj.2023.0022.

Early Aortic Valve Replacement in Symptomatic Normal-Flow, LowGradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study

• Kim K
• Cho I
• Ko KY
• Lee SH
• Lee S
• Hong GR
• Ha JW
• Shim CY

• KMID: 2548236
• DOI: http://doi.org/10.4070/kcj.2023.0022

Abstract

Background and Objectives
Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS.
Methods
Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m 2 , mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm ² ) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization.
Results
During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings.
Conclusions
An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings.

Keyword

Aortic valve stenosis; Surgical valves; Transcatheter aortic valve replacement; Mortality; Heart failure

Figure

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  Figure 1 Survival from composite outcomes of all-cause death or heart failure hospitalization.AVR = aortic valve replacement; HR = hazard ratio.

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  Figure 2 Survival from individual outcomes of all-cause death (A) and heart failure hospitalization (B).AVR = aortic valve replacement; HR = hazard ratio.

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  Figure 3 Forest plot of subgroup analysis.AVR = aortic valve replacement; CI = confidence interval; HR = hazard ratio; LV = left ventricular; PASP = pulmonary artery systolic pressure.

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