Original articleAdult cardiacSurvival Benefit of Aortic Valve Replacement in Patients With Severe Aortic Stenosis With Low Ejection Fraction And Low Gradient With Normal Ejection Fraction
Section snippets
Patient Population
This retrospective cohort study from a large university medical center was approved by our local institutional review board, which waived the need for patient consent because of the retrospective study nature. The echocardiographic database was searched for patients with severe aortic stenosis defined as a valve area less than or equal to 0.8 cm2. This yielded a total of 740 patients. Of these, 194 patients had an LVEF of 0.35 or less and 168 (23%) had a mean transvalvular gradient of 30 mm Hg
Results
To retain clarity, the results are presented in two sections. These include: (A) severe AS patients with LVEF 0.35 or less; and (B) severe AS patients with transaortic mean gradients 30 mm Hg or less.
Our Findings
Our study shows that low EF and low valvular gradient despite normal EF are common in the setting of severe AS, occurring in 26% and 7% of the patients, respectively. There is also a reluctance to offer surgery in these patients with an AVR rate of only 30% despite a large survival benefit. The survival benefit is supported by both sensitivity and propensity score analysis, which are the best available tools to analyze treatment effects in observational data. As a randomized study in this
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