Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis

Authors

Saki Ito, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Roger Laham, Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Vuyisile T. Nkomo, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
John K. Forrest, Department of Internal Medicine (Cardiology), Yale-New Haven Hospital, New Haven, Connecticut, USA.
Michael J. Reardon, Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA.
Stephen H. Little, Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA.
Mubashir Mumtaz, Departments of Cardiothoracic Surgery and Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Wormsleyburg, Pennsylvania, USA.
Hemal Gada, Departments of Cardiothoracic Surgery and Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Wormsleyburg, Pennsylvania, USA.
Tanvir Bajwa, Advocate Aurora HealthFollow
David Langholz, Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA.
John Heiser, Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA.
Atul Chawla, Department of Cardiology, Mercy Medical Center, IA, Mercy Medical Center, Des Moines, Iowa, USA.Follow
Bart Jenson, Department of Cardiology, Mercy Medical Center, IA, Mercy Medical Center, Des Moines, Iowa, USA.
Guilherme Attizanni, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Alan H. Markowitz, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Jian Huang, Structural Heart and Aortic, Medtronic Inc, Mounds View, Minnesota, USA.
Jae K. Oh, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA oh.jae@mayo.edu.

Recommended Citation

Ito S, Laham R, Nkomo VT, et al. Impact of aortic valve replacement in symptomatic low-risk patients with less than severe aortic stenosis. Open Heart. 2023;10(1):e002297. doi:10.1136/openhrt-2023-002297

Affiliations

Aurora St. Luke's Medical Center

Abstract

Objective:To evaluate whether transcatheter or surgical aortic valve replacement (TAVR or SAVR) affects clinical and haemodynamic outcomes in symptomatic patients with moderately-severe aortic stenosis (AS).

Methods:Echocardiographic evidence of severe AS for enrolment in the Evolut Low Risk trial was based on site-reported measurements. For this post hoc analysis, core laboratory measurements identified patients with symptomatic moderately-severe AS (1.0

Results:Moderately-severe AS was identified in 113 out of 1414 patients (8%). Baseline AVA was 1.1±0.1 cm2, peak velocity 3.7±0.2 m/s, MG 32.7±4.8 mm Hg and aortic valve calcium volume 588 (364, 815) mm3. Valve haemodynamics improved following TAVR (AVA 2.5±0.7 cm2, peak velocity 1.9±0.5 m/s and MG 8.4±4.8 mm Hg; p<0.001 for all) and SAVR (AVA 2.0±0.6 cm2, peak velocity 2.1±0.4 m/s and MG 10.0±3.4 mm Hg; p<0.001 for all). At 24 months, the rates of death or disabling stroke were similar (TAVR 7.7% vs SAVR 6.5%; p=0.82). Kansas City Cardiomyopathy Questionnaire overall summary score assessing quality of life improved from baseline to 30 days after TAVR (67.0±20.6 to 89.3±13.4; p<0.001) and SAVR (67.5±19.6 to 78.3±22.3; p=0.001).

Conclusions:In symptomatic patients with moderately-severe AS, AVR appears to be beneficial. Determination of the clinical and haemodynamic profile of patients who can benefit from earlier isolated AVR needs further investigation in randomised clinical trials.

Type

Article

PubMed ID

37173100