Zainab Samad1, Amit N Vora2, Allison Dunning3, Phillip J Schulte3, Linda K Shaw3, Fawaz Al-Enezi4, Mads Ersboll5, Robert W McGarrah4, John P Vavalle4, Svati H Shah6, Joseph Kisslo4, Donald Glower7, J Kevin Harrison4, Eric J Velazquez2. 1. Division of Cardiology, Duke Medicine, Duke University, PO Box 3254, Rm 3347A Duke South, 200 Trent Drive, Durham, NC, USA zainab.samad@dm.duke.edu. 2. Division of Cardiology, Duke Medicine, Duke University, PO Box 3254, Rm 3347A Duke South, 200 Trent Drive, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA. 3. Duke Clinical Research Institute, Durham, NC, USA. 4. Division of Cardiology, Duke Medicine, Duke University, PO Box 3254, Rm 3347A Duke South, 200 Trent Drive, Durham, NC, USA. 5. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 6. Division of Cardiology, Duke Medicine, Duke University, PO Box 3254, Rm 3347A Duke South, 200 Trent Drive, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA Duke Molecular Physiology Institute, Durham, NC, USA. 7. Division of Cardiology, Duke Medicine, Duke University, PO Box 3254, Rm 3347A Duke South, 200 Trent Drive, Durham, NC, USA Department of Surgery, Duke University, Durham, NC, USA.
Abstract
AIMS: We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. METHODS AND RESULTS: The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. CONCLUSIONS: In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We aimed to determine the frequency of aortic valve surgery (AVR) with or without coronary artery bypass grafting (CABG), among patients with moderate/severe aortic stenosis (AS) and left ventricular systolic dysfunction (LVSD), and its relationship with survival. METHODS AND RESULTS: The Duke Echocardiographic Database (N = 132 804) was queried for patients with mean gradient ≥25 mmHg and/or peak velocity ≥3 m/s and LVSD (left ventricular ejection fraction ≤50%) from 1 January 1995-28 February 2014. For analyses purposes, AS was defined both by mean gradient and calculated aortic valve area (AVA) criteria. Time-dependent indicators of AVR in multivariable Cox models were used to assess the relationship of AVR and all-cause mortality. A total of 1634 patients had moderate (N = 1090, 67%) or severe (N = 544, 33%) AS by mean gradient criteria. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. There were 863 (53%) deaths observed up to 5 years following index echo. After multivariable adjustment in an inverse probability weighted regression model, AVR was associated with higher 5-year survival amongst patients with moderate AS and severe AS whether classified by AVA or mean gradient criteria. Over all, AVR ± CABG compared with medical therapy was associated with significantly lower mortality [hazard ratio, HR = 0.49 (0.38, 0.62), P < 0.0001]. Compared with CABG alone, CABG + AVR was associated with better survival [HR = 0.18 (0.12, 0.27), P < 0.0001]. CONCLUSIONS: In patients with moderate/severe AS and LVSD, mortality is substantial and amongst those selected for surgery, AVR with or without CABG is associated with higher survival. Research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Rick A Nishimura; Catherine M Otto; Robert O Bonow; Blase A Carabello; John P Erwin; Robert A Guyton; Patrick T O'Gara; Carlos E Ruiz; Nikolaos J Skubas; Paul Sorajja; Thoralf M Sundt; James D Thomas Journal: Circulation Date: 2014-03-03 Impact factor: 29.690
Authors: M H Hwang; K E Hammermeister; C Oprian; W Henderson; G Bousvaros; M Wong; D C Miller; E Folland; G Sethi Journal: Circulation Date: 1989-09 Impact factor: 29.690
Authors: E Schwammenthal; Z Vered; Y Moshkowitz; B Rabinowitz; Z Ziskind; A K Smolinski; M S Feinberg Journal: Chest Date: 2001-06 Impact factor: 9.410
Authors: James M Brown; Sean M O'Brien; Changfu Wu; Jo Ann H Sikora; Bartley P Griffith; James S Gammie Journal: J Thorac Cardiovasc Surg Date: 2009-01 Impact factor: 5.209
Authors: Sammy Elmariah; Igor F Palacios; Thomas McAndrew; Irene Hueter; Ignacio Inglessis; Joshua N Baker; Susheel Kodali; Martin B Leon; Lars Svensson; Philippe Pibarot; Pamela S Douglas; William F Fearon; Ajay J Kirtane; Hersh S Maniar; Jonathan J Passeri Journal: Circ Cardiovasc Interv Date: 2013-11-12 Impact factor: 6.546
Authors: Hugo G Hulshof; Arie P van Dijk; Keith P George; Maria T E Hopman; Dick H J Thijssen; David L Oxborough Journal: J Physiol Date: 2017-03-09 Impact factor: 5.182
Authors: Stephan M Pio; Mohammed R Amanullah; Steele C Butcher; Kenny Y Sin; Nina Ajmone Marsan; Philippe Pibarot; Nicolas M Van Mieghem; Zee Pin Ding; Philippe Généreux; Martin B Leon; See Hooi Ewe; Victoria Delgado; Jeroen J Bax Journal: Open Heart Date: 2021-06