Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction

作者：Zainab Z. Samad, Amit N. Vora, Allison M. Dunning, Phillip J. Schulte, Linda K. Shaw, Fawaz A Alenezi, Mads Kristian Ersbøll, Robert W. McGarrah, John Paul Vavalle, Svati Hasmukh Shah, JOSEPH A. KISSLO, Donald Duane Glower, John Kevin Harrison, Eric J. Velazquez · 发表于：European Heart Journal · 年份：2016 · DOI：10.1093/eurheartj/ehv701 · 被引用次数：102 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiovascular Function and Risk Factors、Aortic Disease and Treatment Approaches

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 assoc...