P252Low-flow Low-gradient aortic stenosis: prognosis and effect of surgery.


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Abstract

Background: Low-flow low-gradient aortic stenosis with preservedejection fraction is a recently described entity, but its prognosis and influence of surgery are uncertain.Methods: In amulticentre study, 362 patients with severeaortic stenosis (aortic valve area ≤ 0.6 cm2/m2), and preserved LV function (LVEF≥ 50%) were prospectively included. Four groups were defineddepending on flow and gradient: low flow was defined as a stroke volume index(SVi) ≤ 35 ml/m2, and low gradient as a mean gradient (MG) ≤ 40 mmHg.Results: Group 1 (normal flow high gradient) represented themajority of our patients (231 patients, 63.5%). 3-year survival was 87%.Referral rate for surgery was 75%. There was a significant improvement ofsurvival among the surgery group (88% vs75% in the medical group, p=0.035). Group 2 (low flow high gradient) included 46 patients(12.6%). 3-year survival was 95% (p=ns vsgroup 1). Referral rate for surgery was 76%. There was a significantimprovement of survival among the surgery group (100% vs 76% in the medical group, p=0.01). Group 3 (high flow low gradient) included 57 patients(15.7%). 3-year survival was 85% (p=ns vsgroup 1). Referral rate for surgery was 55%. There was a significantimprovement of survival among the surgery group (90.6% vs 74.7% in the medical group, p=0.04). Group 4 (low flow low gradient) included 30 patients(8.2%). 3-year survival was the lowest: 64% (p=0.04 vs group 2). Referral rate for surgery was 56%. However there wasno significant improvement with surgery (3-year survival 61.6% vs 72.7% in the medical group, p=0.93).Conclusion: Low-flow low-gradient aortic stenosis is arare disease, associated with severe prognosis. Its prognosis doesn't seem tobe improved by surgery.

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