P318. Surgical Outcomes of Mixed Aortic Valve Disease : Severe Aortic Stenosis with Regurgitation Exceeding a Moderate Degree
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: A substantial portion of patients diagnosed with aortic stenosis (AS) manifest mixed aortic valve pathology, which includes moderate to severe concurrent aortic regurgitation (AR). However, the clinical and echocardiographic consequences after aortic valve replacement (AVR) of these populations remain less comprehended.
Methods: The study enrolled patients undergoing isolated AVR (n=1,467) between Oct 2000 and Dec 2021. In the AS group (n=1,137, 66.3±9.5yrs, 47.4% female), individuals had mild or less AR combined with severe AS, whereas the mixed AS group (n=330, 64.6±10.8yrs, 39.1% female) presented concurrent moderate to severe AR alongside severe AS preoperatively. The primary and secondary endpoints were all-cause mortality with serial echocardiographic parameters and composite outcomes of death, valve-related adverse events including heart failure requiring hospitalization, reoperation and stroke independently.
Results: In preoperative echocardiography, the mixed AS group exhibited a lower prevalence of bicuspid AV (BAV) (31.5% vs. 49.2%, p<0.001), along with reduced ejection fraction (57.2±11.9% vs. 60.8±10.2%, p<0.001), and larger left ventricular systolic/diastolic dimensions (LVIDs/LVIDd) (37.2±9.1mm vs. 30.4±7.6mm / 55.6±7.7mm vs. 48.4±6.1mm, p<0.001). During a median follow-up of 6.3 years, both groups showed comparable survival rates (P=0.66). However, in patients with tricuspid AV (TAV), the mixed AS group exhibited significantly better survival rates (HR, 0.69, 95% CI, 0.49-0.97, P=0.031), whereas in those with BAV, although not statistically significant, the mixed AS group displayed higher mortality rates (HR, 1.44, 95% CI, 0.92-2.25, P=0.109) in subgroup analysis (P for interaction=0.008) (Figure 1). The composite outcome comprising death and valve-related adverse events, no significant difference was observed between the two groups (P=0.91). The mixed AS group demonstrated a progressive reduction in LVIDs/LVIDd during follow-up period, while the AS group exhibited a noteworthy increase, with statistical significance after AVR (p<0.001) (Figure 2).
Conclusions: The AS and mixed AS group, which underwent AVR, showed comparable survival rates; however, the mixed AS group exhibited more favorable survival rates in patients with TAV. Moreover, LVIDs/LVIDd showed a progressive reduction in mixed AS group in contrast to AS group after AVR. Further studies are required to understand the mechanisms of the study findings.
Authors
Soo Jin Park (1), Kitae Kim (1), Hong Rae Kim (2), Ho Jin Kim (2), Jae Suk Yoo (2), Sung-Ho Jung (2), cheol hyun chung (2), Joon Bum Kim (2)
Institutions
(1) Asan Medical Center, South Korea, (2) Asan Medical Center, Seoul, Korea
Methods: The study enrolled patients undergoing isolated AVR (n=1,467) between Oct 2000 and Dec 2021. In the AS group (n=1,137, 66.3±9.5yrs, 47.4% female), individuals had mild or less AR combined with severe AS, whereas the mixed AS group (n=330, 64.6±10.8yrs, 39.1% female) presented concurrent moderate to severe AR alongside severe AS preoperatively. The primary and secondary endpoints were all-cause mortality with serial echocardiographic parameters and composite outcomes of death, valve-related adverse events including heart failure requiring hospitalization, reoperation and stroke independently.
Results: In preoperative echocardiography, the mixed AS group exhibited a lower prevalence of bicuspid AV (BAV) (31.5% vs. 49.2%, p<0.001), along with reduced ejection fraction (57.2±11.9% vs. 60.8±10.2%, p<0.001), and larger left ventricular systolic/diastolic dimensions (LVIDs/LVIDd) (37.2±9.1mm vs. 30.4±7.6mm / 55.6±7.7mm vs. 48.4±6.1mm, p<0.001). During a median follow-up of 6.3 years, both groups showed comparable survival rates (P=0.66). However, in patients with tricuspid AV (TAV), the mixed AS group exhibited significantly better survival rates (HR, 0.69, 95% CI, 0.49-0.97, P=0.031), whereas in those with BAV, although not statistically significant, the mixed AS group displayed higher mortality rates (HR, 1.44, 95% CI, 0.92-2.25, P=0.109) in subgroup analysis (P for interaction=0.008) (Figure 1). The composite outcome comprising death and valve-related adverse events, no significant difference was observed between the two groups (P=0.91). The mixed AS group demonstrated a progressive reduction in LVIDs/LVIDd during follow-up period, while the AS group exhibited a noteworthy increase, with statistical significance after AVR (p<0.001) (Figure 2).
Conclusions: The AS and mixed AS group, which underwent AVR, showed comparable survival rates; however, the mixed AS group exhibited more favorable survival rates in patients with TAV. Moreover, LVIDs/LVIDd showed a progressive reduction in mixed AS group in contrast to AS group after AVR. Further studies are required to understand the mechanisms of the study findings.
Authors
Soo Jin Park (1), Kitae Kim (1), Hong Rae Kim (2), Ho Jin Kim (2), Jae Suk Yoo (2), Sung-Ho Jung (2), cheol hyun chung (2), Joon Bum Kim (2)
Institutions
(1) Asan Medical Center, South Korea, (2) Asan Medical Center, Seoul, Korea
Presentation Duration
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