P677Postoperative total hemodynamic load is an independent predictor of events after aortic valve replacement in isolated aortic stenosis


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Abstract

Purpose: Residual left ventricular (LV) hypertrophy after aortic valve replacement (AVR) was shown to be an independent predictor of worse outcome in aortic stenosis (AS), but concomitant regurgitation and coronary artery disease (CAD) may have confounded results. Our goal was to evaluate the impact of LV mass (LVM) regression on clinical events in a homogeneous cohort of patients (pts) with isolated AS.Methods: Consecutive pts with severe isolated AS for elective AVR were prospectively enrolled. Exclusion criteria: atrial fibrillation, significant CAD (>50% stenosis), other significant (>grade II) valvular lesions. Demographic and clinical data were collected. Baseline and 6 months echocardiographic data were recorded according to the recommendations of the American Society of Echocardiography. Perioperative complications and events (readmission, rhythm change, prosthesis related complications) were registered at the 6 months follow-up. Continuous variables are: mean±SD, for simplicity sake. Statistical tests were performed according to variable distribution. P<0.05.Results: Seventy-eight patients (64.6±12.4yrs, 54% female and 54% hypertensive) underwent AVR (67.9% biological, 77% sizes 21-23). Eight (11%) pts had events at 6 months: readmissions (4), atrial fibrillation (1), and prosthesis dysfunction (3). LVMi decreased 11±21% (114.3±31.5 g/m2 at 6 months vs 131.4±33.6 g/m2 at baseline, p<0.001). Regression of LVMi was inversely correlated with initial LVMi (r=-0.43; p>0.001) and it was higher in non-hypertensives (-18.1±18.6% vs -5.0±21.4%, p<0.01). There was a trend for lower LVMi decrease in pts who had postoperative events (2.7±24.3% vs -12.3±20.6%, p=0.11), and events were more frequent (7 vs 1, p=0.05) amongst those whose LVM regressed less than the mean. Pts with events had a higher total hemodynamic load evaluated by valvuloarterial impedance (Zva) at 6 months (5.5±1.0 vs 3.6±1.1 mmHg/ml/m2; p<0.001). Indeed, only Zva was an independent predictor of events in binary logistic regression (p=0.018).Conclusion: Our study suggests that although both LVMi decrease lower than 11% and higher total hemodynamic load correlate with 6-months events after AVR in isolated AS pts, only the latter is an independent predictor. Determination of Zva should be part of routine evaluation of AS patients, even after AVR.

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