David Playford1, Simon Stewart2, David Celermajer3, David Prior4, Gregory M Scalia5, Thomas Marwick6, Marcus Ilton7, Jim Codde8, Geoff Strange8. 1. School of Medicine, University of Notre Dame, Fremantle, Australia. Electronic address: dplayford@neda.net.au. 2. Torrens University Australia, Adelaide, Australia. 3. Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 4. University of Melbourne, St Vincent's Hospital, Melbourne, Australia. 5. Faculty of Medicine and Health, University of Sydney, Sydney, Australia; University of QLD, The Prince Charles Hospital, Brisbane, Australia. 6. Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 7. Menzies School of Health Research, Royal Darwin Hospital, Casuarina, Australia. 8. School of Medicine, University of Notre Dame, Fremantle, Australia.
Abstract
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.
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.
Authors: Nicholas Collins; Stuart Sugito; Allan Davies; Andrew Boyle; Aaron Sverdlov; John Attia; Simon Stewart; David Playford; Geoff Strange Journal: Pulm Circ Date: 2022-10-01 Impact factor: 2.886
Authors: Afik D Snir; Martin K Ng; Geoff Strange; David Playford; Simon Stewart; David S Celermajer Journal: J Am Heart Assoc Date: 2021-10-30 Impact factor: 5.501
Authors: Geoffrey A Strange; Simon Stewart; Nick Curzen; Simon Ray; Simon Kendall; Peter Braidley; Keith Pearce; Renzo Pessotto; David Playford; Huon H Gray Journal: Open Heart Date: 2022-01
Authors: Simon Stewart; Clifford Afoakwah; Yih-Kai Chan; Jordan B Strom; David Playford; Geoffrey A Strange Journal: Lancet Healthy Longev Date: 2022-08-18