Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction

OBJECTIVES We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low tranvalvular gradient (TVG) is associated with improved survival. BACKGROUND The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial. METHODS Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area less than or equal to0.75 cm(2), LV ejection fraction less than or equal to35% and mean gradient less than or equal to30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group. RESULTS Despite well-matched baseline characteristics among propensity-matched patients, the one and four-year survival rates were markedly improved in patients, it) the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001) The only other predictors of mortality were age and the serum creatinine level. CONCLUSIONS Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival. (J Am Coll Cardiol 2002;39:1356-63) (C) 2002 by the American College of Cardiology Foundation.